The patient is a 36-year-old- male who was bullied by peers and was emotionally abused by his father for being effeminate and preferring to play with dolls. These adverse childhood experiences made him vulnerable to depression. He told himself that he could no longer rely on anyone else but himself and took pride in his independence. He gave his best with his endeavors and did not settle for mediocrity, frequently reviewing his work. During the pandemic, he experienced several hardships such as disruption of activities, inability to meet the financial needs of his family and unemployment. He found himself struggling but surviving. While in a work-from-home arrangement, he was so frustrated about his internet connection that he complained on social media. The internet company then threatened him of possible legal charges and felt stuck in a hopeless situation. This affected his day-to-day activities until he felt so overwhelmed that he attempted suicide by ingesting multiple medications. He was then brought to the emergency room and was admitted. He was diagnosed to have Major Depressive Disorder and was started on antidepressants. Psychotherapy focused on identifying stressors and strengthening adaptive coping mechanisms while he was admitted at an isolation facility. He then followed up at the outpatient department of a tertiary government hospital in Mindanao with noted improvement in mood and functionality overtime. During admission, he was also diagnosed to have Diabetes Mellitus and COVID-19, which added to his burden as these were the biologic factors that were correlated to his depression. The case highlighted the interplay between the effects of multiple traumatic experiences in a vulnerable individual and thus necessitating a holistic management.
Depressive Disorder, Major ; Psychiatry ; Suicide

Objective. This study aimed to examine capacities and initiatives of the local government units (LGUs) in the Philippines in producing, recruiting and retaining human resources for health (HRH).

Methods. This 2-phase, descriptive, cross-sectional study employed multiple methods such as key informant interviews (KIIs), focus group discussions (FGDs) (for Phase 1) and surveys (for Phase 2) in rural municipalities across the country. Phase 1: We employed qualitative methods to develop a quantitative questionnaire in 22 purposefully selected municipalities. An exhaustive enumeration of responses from the guide questions of the FGDs and KIIs were then translated into a questionnaire. Phase 2: We administered the survey questionnaire from phase 1 to another 67 municipalities to obtain a greater representation of the intended study population as well as quantify results from the qualitative methods. We analyzed data with descriptive statistics.

Results. Initiatives in HRH production were mainly on provision of scholarships. Active recruitment was not done due to lack of available pool of applicants, lack of vacant positions, financial constraints leading to utilization of deployment programs and temporary nature of employment. Recruitment was influenced by budgetary constraints, political biases, dependency on deployment programs and other hired temporary HRH, and set health worker-to-population ratios. Initiatives to retain HRH were largely financial in nature based on pertinent policies. The capacities of LGUs to produce, recruit, and retain needed HRH were strongly dependent on the internal revenue allotment (IRA), along with their local income.

Conclusion. Rural municipalities in the Philippines have initiatives to produce, recruit, and retain HRH. However, these are not enough to meet the needed number of competent and highly motivated HRH that are expected to respond to the unique needs of the rural municipalities. Strategies to increase the capacity of LGUs, address the shortage of HRH, and increase motivation of HRH are recommended.

Economics ; Primary Health Care