Cardiovascular diseases rank number one among the ten leading causes of mortality in the Philippines for both men and women. This was just another medical fact for me, until I actually saw how such diseases stealthily impinge on the lives of Filipinos, and in particular, women. My initial exposure to cardiovascular cases was in a small community in Sampaloc, Manila. My partner and I were assigned to the family of a 70-year-old lady called Tea, who lived with her husband and two daughters. Tea is a known hypertensive. She has twelve children; one of whom cares of her. The second daughter, who is married, continues to live with her. She lives in a simple dwelling made of light construction materials in a poor urban community. Her house has two floors, with ceilings so low that she has to walk with her head bent down. Now retired from the cleaning service, she obtains income from a small store she put up in front of her home. Apart from that, she lives on her husband's retirement savings. She faithfully goes to a doctor for check-up and if she can afford it that month, might buy half the recommended dosage of any medicine prescribed. We recommended a healthy diet which she appeared to have understood, but somehow, we knew she would eat whatever was served in the table. We gave her pamphlets and repeatedly counselled her and her family about lifestyle modification. After six months, we returned to check her progress but Tea was not home. We found out that she had been taken to a nearby Hospital for coronary artery disease.

Tea's daughter, Emilia, is also a known hypertensive. She has three children. She spends her days taking her children to school (less than a mile away), keeping the house clean and attending acupuncture sessions. She too faithfully visits a doctor for regular check-up. She checks her own blood pressure and never fails to visit her doctor whenever she feels something wrong. We gave our recommendations and then came back to follow-up their fulfilment of those after six months…

The family was generally conscious of their health. I was amazed at how readily they seek medical attention whenever they feel something abnormal happening in their bodies. At first, such an attitude relieved me since it gave me confidence that my job (to encourage them to adopt healthy behaviours) would be effective. However, when we met them the second time and asked for their feedback regarding our recommendations and family health care plan, I soon grasped their real outlook on health. Upon my inquiry about their compliance, one of the patients smiled shyly at us, not knowing how she could look straight into our eyes, telling us she forgot where she kept all the pamphlets. Without losing heart, I asked whether they at least read the pamphlets before losing them. And with that same smile, she coyly admitted she never perused through them. Mustering all my patience, I tested her recall of each recommendation we gave at our last visit. After all the rapport and active interaction we had in the previous visits, I still believed at this point that she practices or at least remembers most of the advice we gave her family. However, nothing much changed. Due to lack of money, compliance with medication remains poor. More so, there does not seem to be a positive attitude towards applying preventative measures such as avoiding fatty or salty foods and doing exercise. Perhaps they believe that regularly seeing the doctor is the sole principle in maintaining one's well being.

Indeed, one cannot change people overnight. Visiting a family for one hour a week for one month and again after six months is not enough to impress upon them the virtues of primary health care. I was lucky to land on a family that was accommodating. They expressed almost everything that occurred in their lives, narrated whatever they can remember about their illnesses, and listened intently to us mere medical students. Despite the little time we had with them, we were able to get enough information.

The underlying problem is, however, the lack of personal responsibility for one's health through a healthy lifestyle, of the family assigned to us may just be the same one among the other families living in a community. It apparently has not been uprooted and perhaps it would take many more years to eradicate personal habits.abits.

Notwithstanding my initial disappointment, I realized that there is hope for these two hypertensive women we had taken care of. Encouraging them to continue going regularly to the doctor is one big leap. Fostering the attitude of following preventive measures given by the doctor is yet another step; and I can proudly say my group mate and I have tirelessly sown the seed. But the growth and the watering of that seed must now be taken over by those who can better take care of them - the next medical students assigned to them, or better yet, the local health workers who must unstintingly see through the specific needs of the community and promote wellness as a personal responsibility.

Beverlee Verona L. Mante (Philippines) University of Santo Tomas bvlmante@yahoo.com