Dr. Fred Ng (left) gives a free medical consultation to a patient at a Carolina Medical Mission in Parañaque. / Photo courtesy of Spencer DempseyÂ

“Filipinos will always want to go back,” says Dr. Daniel Vicencio, Medical Director of Mercy Family Health Center. “You’re going ‘home.’ You’ve been here 20 years yet you still want to go home.”

The sentiment may hold for Filipino Americans as they age, but it’s far more complicated. Half of 35 immigrant seniors surveyed between 2008 and 2010 still plan to move back to the Philippines, according to the Filipino American Senior Health Assessment, a longitudinal study conducted by the Filipino American Community Health Initiative of Chicago.  The other half don’t , and a handful aren’t sure.

Dr. Fred Ng, a retired Chinese-Filipino-American surgeon, shares the desire to return for good. As the chief surgeon for the Carolina Medical Mission, he returns about twice a year to provide medical procedures to those who can’t afford care. He laughingly remarks that he misses “nothing” about the United States while he is back in his homeland, but like many older immigrants, having family in the States is keeping him from relocating permanently.

While Ng returns to help his fellow countrymen, many Filipino-Americans return for more personal or financial reasons.

“They want to return to derive maximum benefits from savings,” says Leo Herrera-Lim, Consulate General for the Philippines. “Cost-of-living compared to the United States is 1 to 5. In the Philippines, you pay about 20 percent of what you would pay for basic goods in the United States.”

The comparatively low cost-of-living applies to more than clothing and groceries; it makes school more affordable as well.

“One year of university costs about $3000 to $4000, about one-tenth of the cost of a U.S. education,” Herrera-Lim says. “It’s a significant difference.” And many Filipino doctors and students view medical school in the Philippines as equivalent to a U.S. medical education.

Dr. Daniel Vicencio (second from left) speaks at a Filipino American Community Health Initiative of Chicago forum. Vicencio has become active in improving Chicago's Filipino-American community. / Photo by Corinne Chin

“The education process is the same. Everything is based on the American standard,” explains Steve Unciano, a Filipino-American doctor and owner of Unciano General Hospital in Mandaluyong, Philippines. “[Filipino graduates] are pretty much shoulder to shoulder with U.S. graduates.”

Although low costs tempt many Filipino-Americans—from Philippine-born retirees to American-born students—to return, memories of a disjointed health care system keep some away.

“The only problem we have is about health care,” says Aurora Nepomuceno, a retired nurse who immigrated in 1972. Since their retirement began, the Skokie resident and her husband have been spending October through April of every year in the Philippines.

“The problem in going back to the Philippines is that when you get sick, you spend your own money. I prefer to stay in the United States because of health coverage,” Nepomuceno says. “It’s good that when my husband got sick this year, we were here in the United States. We have money from retirement, pensions, social security and health insurance.”

These problems echo those shared by other Filipino-Americans.

“The main concern of immigrants going back is if they’re covered by insurance or Medicare,” Unciano says. “I think that it will be of assurance [to those returning] to know they will be covered if it’s an emergency and, if it’s elective care, they just have to ask their respective insurance beforehand.”

Although his hospital, much like American hospitals, treats patients before they pay, Unciano explains that most other hospitals in the Philippines will not treat anyone, even emergency room patients, before receiving payment. This system limits the health services for those who can’t afford it.

“When you are poor, nobody helps you. Even if you go to a so-called charity hospital, you have to come up with some money,” Ng says.

Additionally, if a patient cannot afford to pay for diagnostic tests, they opt not to take the potentially life-saving exams.

“Often when they finally come to see a doctor, their condition is too advanced to cure, and they are left to die at home,” Ng says.

A student at the University of the East – Ramon Magasaysay Medical Center, who asked to remain anonymous, believes no solution will lead to real change.

“It would be nice if insurance would be provided or some law be decreed so there could be equal opportunity to have better health,” she says. “Even if the World Health Organization gave money, there would always be corruption in the government.”

Some Filipino-Americans remain optimistic, especially because recently inaugurated president Benigno Aquino Jr. has promised to rid the government of corruption.

“Minus corruption, we will have more funds to help people as far as health care is concerned,” says Dr. Philip Chua, a cardiac surgeon based in Northwest Indiana.

Despite the quality of Filipino doctors, many Filipino-Americans believe that health care in the Philippines is substandard to care in America, especially because many areas suffer from a lack of resources.

“The view…is to a degree correct,” Vicencio says. “In the United States, if you’re sick, we can and will do anything for you to keep you alive and well. In the Philippines, they treat you as if you’re not going to be living forever.”

Perhaps more importantly, technology also does not always measure up to U.S. standards.

“I would say 30 percent [of Philippine hospitals] would have state-of-the-art facilities like we have in the United States, but the rest would be five years behind as far as equipment is concerned,” Chua says.

However, some do not see the technology divide as a disadvantage. American-born Mark Unciano, one of Steve Unciano’s sons, is currently a medical student at University of Perpetual Help at Las Piñas.

“There’s another way to diagnose different diseases. They teach us the old fashioned way with a stethoscope,” Mark Unciano says. “I actually feel that I may have an advantage…working my way through the kinks without using technology to make these diagnostic decisions.”

Access to health care can also be a problem.

“The ambulatory system is nowhere near as good as in the United States with all the traffic [in the Philippines]. If you have a heart attack at home you might not make it to the hospital… You won’t always have angiograms when you need them; there’s no dialysis right away when your kidney fails. Access is the problem,” Vicencio says.

Some Filipino-American doctors return to their homeland in hopes of helping solve these problems. In 1997, Chua’s success in the United States motivated him to help establish the open heart program at Cebu Doctors’ University Hospital. He returns about every two months to the Philippines.

“I felt I was abandoning my native country and was busy making money,” Chua says. “I felt a sense of inner guilt. I promised myself to find a way of giving back to my motherland.”

Sixty-five Carolina Medical Mission volunteers traveled to the Philippines in January 2010. They offered free medical and dental exams to over 3 thousand patients. / Photo Courtesy of Spencer Dempsey

In the coming months, eight medical missions comprised of Filipino-American doctors are traveling to the Philippines from Illinois, Michigan and Minnesota, Herrera-Lim says. Medical missions, like Ng’s Carolina Medical Mission, generally bring groups of American doctors to impoverished parts of the Philippines to provide free short-term medical care.

Vicencio finds faults with the medical mission model. He says he would love to help the poor of the Philippines, but his personal focus is primary, longitudinal care. He argues that the medical missions accomplish “nothing on a sustained basis. They don’t go back to teach, run clinics, seminars or organizations. They treat people, and then they leave…I’d much rather be a consultant.”

The student at the University of the East – Ramon Magasaysay Medical Center agrees. “They go to an area and give some medications, but after they leave there’s nothing really left in the community,” she says. “It somehow imposes dependency on the part of the Filipinos if they count on this [free] health care.”

Chua is accustomed to this criticism, but he still maintains the value of the missions.

“The only thing we tell them is ‘Yes, that’s true.’ We are not there 365 days a year, but the couple of thousands we help during each visit are a couple of thousand being serviced who would otherwise not get medical care,” he says.

Another problem emerges from the disparities between Philippine-trained and American-trained doctors, which can create a resentful working environment. American doctors who serve medical missions bring knowledge of “great tools and equipment,” Vicencio says, but ultimately leave the Philippine doctors with the patients and without the desirable technology.

But Christian Unciano, son of Steve and brother of Mark, and a University of Perpetual Help at Las Piñas medical student, says nationality should not matter.

“We [doctors] all know the same thing when it comes to helping people,” he says. “Race should not be an issue.”