Conversation with Hazel Paragua-Zuellig: The Epilepsy Manager Programme

by Mianmian Fei

APC member, David Zuellig, trustee of the Zuellig Family Foundation, is a keen philanthropist in health enhancement in the Philippines.  One of the projects the foundation has been supporting since 2013 is the Epilepsy Manager Programme under the Philippine League Against Epilepsy (PLAE).  Leading this programme is David’s wife Hazel Paragua-Zuellig, an epilepsy specialist and the former president of PLAE.  She is currently on board of the International League Against Epilepsy (ILAE) and the chairman of its Access to Medicine Task Force.  Before a roundtable lunch in March, Hazel sat down with APC at Shangri-La Hotel Singapore to share her involvement in the programme and her endeavour enhancing the livelihood of epilepsy patients in the Philippines.

Characterised by seizures, epilepsy is one of the most common neurological disorders which can occur in any stage of life.  The condition can be traced to various factors, including genetic influence, infectious diseases, and brain injuries.  Although frequent seizures may lead to mental retardation, it is preventable through early treatment using medication.  Hazel affirmed that the treatment is easy and affordable.  “For the price of one Big Mac, medication can be bought to make a child seizure-free for a month”, she said.  As a result, with proper diagnosis, right prescription, and continuous access to medication for two to three years, a patient can be seizure-free and get back to normal life.

However, currently, among the 1.5 to 2 million Filipinos with seizure, there are only 350 neurologists available, and only around 20 of them specialise in epilepsy.  In addition, 95% of these neurologists are in Manila, whereas some provinces do not have a single neurologist.  Therefore, many patients in far-flung provinces have no choice but to live with epilepsy, since they cannot afford to travel for hours to seek medical help.  It is estimated that 85% of Filipinos burdened with epilepsy do not have access to proper consultation and medications.

Realising the wide gap between competent doctors and epilepsy patients in the Philippines, PLAE started the Epilepsy Manager Programme in 2004.  The programme selects doctors in remote provinces and brings them to Manila for an intensive two-day training on the diagnosis and treatment of epilepsy.  After these doctors return to their provinces, they then set up epilepsy clinics.  In the following year, neurologists from PLAE visit these clinics each month to monitor the doctors’ performance.  At the end of the year, these doctors go to Manila again for a final exam, and upon passing the exam, they are awarded the title “Epilepsy Manager”.  PLEA not only connects these Epilepsy Managers to the nearest neurologists for future reference, but also continuously invites the managers to professional events to keep them updated.  Eventually, PLAE hopes to make available a doctor competent in epilepsy care within one-hour bus ride from every patient’s home in the Philippines.  Besides providing doctors training, the programme holds livelihood workshops, such as soap making and meat processing, for patients and their families to help them afford medication.  In 2008, the programme also raffled off its Sari-sari Store Livelihood Packages to help selected patients and their families start up small stores to further sustain their livelihood.  Up to now, 30 Epilepsy Managers have been trained, and the programme has been recognised by LIAE as a model for potential programmes in other countries.  Hazel is also invited to the International Epilepsy Congress in Bangkok this June to present the programme’s results.

Hazel identified the lack of funding as the primary challenge of the programme, especially after PLEA lost its funding from pharmaceutical companies because of potential conflict of interest.  Even with proper diagnosis and prescription by Epilepsy Managers, some patients still could not afford further medical testing and medication.  Luckily, David stepped in when Typhoon Haiyan hit the Philippines in 2013.  The generous donation from the Zuellig Family Foundation enabled consistent supply of epilepsy medicine in areas where pharmacies were closed, and the rest went into the Epilepsy Manager Programme to pay for check-up tests and ensure monthly supply of medicine for patients.

When asked if she has any plan to scale the programme up, Hazel laughed and said “we need more Davids!”  Indeed, the programme is currently run by a small team of around 20 neurologists who volunteer their time outside of their jobs, and since the follow-up lasts a whole year, the programme can only take four to six doctors each year.  Hazel believes that compared to conventional medical mission trips that normally last two to three days, the long span of the programme enables doctors to not only establish permanent clinics but also train other doctors and health workers in their areas, eventually helping the programme reaching its goal.

Hazel’s next step in her philanthropy journey is to tackle the lack of medical doctors in the Philippines, which she identifies as the root cause of the inadequate epilepsy care in the country.  Her alma mater, the University of the Philippines, can only take 160 medical students each year because of its limited budget, and about 75% of them eventually go abroad.  She also predicts a growing need in the Philippines for medical doctors in the following years, as President Duterte just signed the Universal Healthcare Act this February.  Hazel sees the need to increase the capacity and quality of medical education in universities, as well as planting the seeds of serving the Filipinos in medical students.  APC was thrilled to learn that she and David are considering putting up their own foundation to further support this cause.