A LOVE LETTER TO THERAPISTS
The average monthly salary of a therapist in the Philippines ranges from 8,000Php to 12,000Php (155USD – 230USD) per month, compared to about 7,000USD (364,000php) per month practicing in the USA. A month’s worth of salary in the USA is more than 2 years of work in the Philippines, I am only talking about the median here, believe me, I was there for 11 years and it could be more depending on the gig. That is equivalent to a lot of work for less pay in the Philippines handling at least 10-15 patients a day. I cannot and will not blame you for itching to get out of this country as soon as you get hold of that diploma, again, I have been in your shoes.
With the same mindset mid-college until after graduation, poverty stricken and a frustrated physician among others, all I wanted was to earn and recover the tuition fee my parents struggled like a dog to pay for, and hopefully save enough to pay for all the requirements for my entry to the USA as a therapist. Not familiar with the inner workings of an average therapy/rehabilitation facility on any setting (adult, pediatrics, mental dysfunction, etc.), I thought I was ready but in fact, all I had was a one year rotating internship experience and nothing more. I was hopeless and needed to get a job quick. Board examination in the Philippines for therapists are being held 2 times per year, February and August, graduation is around March or April so ideally, newly graduated therapists schedule their board exam on February of the following year to have enough time to prepare. Desperation whispered in my ear to take the August board examination because if I was to wait until the following year along with the rest of my batch, that would mean a lot will pass and all of them would be rivals for employment. I belligerently took the exam with a heavy heart and passed hanging by a thread, serendipitously at 75 percentiles on all subjects. I thought maybe I did not really pass all subjects but the machine that corrected my exam paper recognized the blotches of dried desperate teardrops all over the sheets and gave me the benefit of the doubt. I was so proud of myself, knowing that I was a level up closer to my goal.
Work experience is a requirement to work in the USA, I applied as soon as I can so as not to waste time. Luckily, I volunteered in a government hospital (Jose R. Reyes Memorial Medical Center) with an OT staff on his way out abroad. I took over his position that same year with a glimmer of hope, delightedly expecting to get the high pay they falsely promote when you work for the government. For more than 5 years of service, I acquired and was a proud owner of an ipod nano, the lowest gigabytes available then and a surplus rusty bicycle I repainted yellow that I rode almost regularly by Manila bay towards Mall of Asia along with the heavy hitters, riding their feather weight carbon bicycles. I also acquired quite a lot of debt to pay for the examinations and other requirements for my application to work in the USA. I applied on all government loans that I qualified for and I don’t even remember paying for them afterwards. Paying for weekly meal dues from a carinderia (side walk food vendor) was a struggle every time in that span of time. Laundry? I bring them home every weekends at my parents because it is just too expensive to pay 30php/kg. Imagine acquiring 4-5kg worth of dirty laundry in a week, that is at least 150php off my 600php salary in a day if I choose to bring it to the laundromat.
Fortunately, after a little more than 5 years, my stars aligned. My name was hand picked amongst thousands of foreign citizens and was granted a working visa for the USA in 2007. From then on, I have been grateful for all the things the country of the United States of America provided me.
I thought this was supposed to be a love letter addressing other therapists? Where is therapy in all this blubber? As you noticed, it was all about me and my struggle to make better for myself, the idea of patient care on top of it came in last or not even on my priorities then. I admit, I was not the ideal therapist to look up to. I rank my skill set as fair, more of a mediocre level. I just imitated most of the techniques I knew from my internship coordinators/supervisors and took them as my own. All these added up to the idea that I was not in the mind set of doing the best for my patients, but more about getting back the money my family and I invested on my education as soon as I possibly could. When is the turning point you may ask? Honestly speaking, not a few years ago when I started working in the United States nor was having my first born who is now 6 years old. You see, I left my family in the Philippines and lived/worked in the USA for 11 years, there I met and made friends with patients who mostly lived on their own. The struggle is very real when you are alone, sick and unable to do a lot, you are an old person on top of it too. Soiled diaper for days, sleeping on your own filth, house wreaking with the smell of urine and feces from your pet and yourself, fridge smelled of spoiled-expired foods, pills-trash-dirty rags and clothes all over the place, dry-broken-heavily rash infested skin and eternal emptiness, depression and pain are a few descriptions of a lot of my patients. These patients would contest that they were in constant rotation of therapists for as long as they could remember. I felt ashamed, guilty and not deserving of all the prestige the title holds. I hated myself because of the idea that I belong to a community who took an oath to make a disabled body able again, empower him/her yet looking at the general population, it was a unanimous failure on my part and the system. I could not help but see myself in their shoes, realizing that it could be me in the future or my loved ones especially my newly born kid. I could not stand the idea of another therapist giving me false goals and for lack of a better word half-assing my care. Truth to say, I noticed this mind set with a lot of the therapists I encountered along the way, international and domestic, money driven therapists who see patients as numbers as opposed to human beings. I am not exempted from this. To therapists, you know who you are, and it does not matter if you are a veteran or a newbie in this field. Here are some of the descriptions I observed. The worst therapists are the ones who are hyperaware and attentive of time, the ones who work on the dot without an agenda in mind, not goal but time specific. Their worth is how much time they spend with the patients without minding the quality of treatment. Next, highly pronounced in the pediatric rehab settings, are the newbies who can afford to put up shop because mom and dad can set-it up for them regardless of the cost. Return of investment is going to be easy because they can mark up the price to a premium because desperate parents would pay an arm and a leg, actually their hearts and souls just to give their kids the best of care. Unfortunately, these therapists are unseasoned business minded individuals without genuine interests in taking care of those poor kids. How about the modality dependent therapists? These are the ones who uses modalities as canes to kill time and because they do not have the skill set, they are more of a sales representative than a therapist. They do not know much about the profession but could sell state of the art modalities like hot cakes despite the fact that we all know they do not do much for the interests of the patients. The last one on the top of my list are the illusionists, quack doctors and faith healer therapists who swear to enable a patient with the littlest theory and skill they know about the practice of the profession. They may not have the skills but they are sweet talkers. They mastered rapport in college really well after those regular internship program, ‘grand duties’ we call it then hanging out and getting wasted with other students they met during their training. These therapist in ratio projects at 90 percentile with 10 percentile skills/knowledge or less.
Karma is a bitch, pardon my ape head thinking. I am not the smartest in this bunch and I don’t read as much. I am not squeaky clean and never will be, but my moral compass is not as skewered like a lot of people-therapists I encountered along the way and continue to observe. To my beloved colleagues, you have my sympathy all the way and I feel bad that we do not get the compensation or royalty we deserve from all the things we do to our patients but it does not mean we give up our own morality. It is not our patients fault that the system is against us, they are not aware too. Like you and me, these people are also suffering and fighting their own fights only in a different set up, far worse when compared to what we are dealing with. Please do not give up on being right and righteous and give them what they deserve, that is, the right for a proper, goal specific and empowering therapy service that they will benefit from to enjoy a life worth living. How about we start seeking for relevance instead of financial stability, fame and prestige for a change?
Ariel Sillano, OTRP, OTR, NASM CPT, NASM CES, Founder KILOS DAVAO
