MISSING MOMMY. Macoy Leyba has learned to cook, take care of the children, and balance the family budget, but he still misses his wife everyday. [photos by Alecks P. Pabico]

WHEN RCHARD Lariosa passed the medical board exam in late 2001, he did one thing most new doctors would not even think of. Then 26, Lariosa passed up residency training and applied at the Department of Health (DOH) to be a barrio doctor.

Eight months later, the young doctor was on an outrigger to Tagapul-an, a fifth-class mountainous island town in Western Samar oft-buffeted by the fickle, perilous amihan and habagat, or the northeast and southwest monsoons.

"What's he doing out there?" Lariosa's incredulous professors at the Manila Central University asked. They had expected Lariosa, who had finished seventh in his class, to be where most doctors dream of working: in a hospital here or abroad.

But Lariosa's heart had been set on joining the Doctors to the Barrio (DTTB) program. "Patok si Flavier then. All the stories about his barrio doctor days piqued my interest," Lariosa says of Senator Juan Flavier, who had launched the program in 1993 when he was health secretary.

Flavier's "Project 271," as the DTTB program was first called, aimed to send doctors to 271 fifth- and sixth-class towns that hadn't had a resident physician in at least 10 years. Flavier had appealed to young medical graduates, especially those from the heavily state-subsidized University of the Philippines, to serve in the countryside.

Since then, more than 400 doctors have been fielded in nearly 300 towns. The program's success can be gauged partly from the fact that impoverished towns now need only to have been doctorless for two years to convince the national government to assign them a rural health physician. In 2003 and 2004, the DOH shortlisted 33 poor towns in need of one. This year, it is considering sending 25.

The DTTB program has undergone major changes as well. In 2002, it became two-track. Doctors can opt for the "classical" program, where they serve for two years. Or they can go for the Leaders for Health Program, like Lariosa did. This means serving three to four years while earning a master's degree in community health management from the Ateneo de Manila University.

But interest in the program has flagged. "It's worrisome," acknowledges Rodel Nodora, the program's coordinator at the DOH. He traces the dwindling number of applicants in part to the rising number of doctors who are leaving the practice to train as nurses and work overseas.

In 2002, 85 applied and 40 were accepted, half for the two-year program and the other half for the Leaders program. Last year, only 35 doctors enlisted. But the Leaders track alone had 30 openings and only 18 of the 35 applicants passed the screening. So all of them wound up in the new program. Municipal health officers got the remaining slots. "The pool from which we are getting the doctors is getting smaller," says Maritona Labajo, assistant director for field operations of the Ateneo program.

ALTHOUGH FLAVIER'S chief target were the graduates of U.P., those from other schools have seemed more eager to serve as barrio doctors. In the program's first year, only one UP alumnus- Henry Plaza-heeded the call, and since then only a few UP graduates have signed up. Lariosa, who did his internship at the Philippine General Hospital, says all his fellow interns at the UP have gone to the United States.

Nodora, himself an ex-barrio doctor who was assigned in 1999 to San Dionisio town, 110 kilometers northeast of Iloilo City, was from the University of the East medical school. So was his predecessor, Dorie Lynn Balanoba, who was in the first batch of 46 doctors sent to the countryside in 1993.

Balanoba graduated in 1989 but found residency training not quite her cup of tea. She was working part-time in different hospitals in Metro Manila when she saw Flavier on television appealing to doctors to serve in rural areas. She was posted in rebel-infested Jipapad, Eastern Samar's northernmost town, and then opted to work for the DOH afterward.

Nodora, for his part, was inspired by a speech then Health Undersecretary Jaime Galvez Tan gave at his graduation. Nodora swore he would join the program after passing the medical board exam. "I know it sounds corny, but I wanted to render service," he says.

Many of the barrio doctors are driven by their desire to help, sense of service, and spirit of nationalism. But Labajo has discovered that early exposure to the community during medical training, instead of a lopsided emphasis on clinical practice, whets a doctor's desire to work among the needy. The UP College of Health Sciences in Palo, Leyte, for example, trains doctors in community-based healthcare. The Ateneo de Zamboanga requires medical students to render internship in the community. The Pamantasan ng Lungsod ng Manila exposes interns and residents to urban-poor neighborhoods. All of these schools have produced volunteers for the Doctors To The Barrio program.

But medical students trained mostly in sophisticated technology and equipment in a hospital setting get a rude awakening when they work in a small town or province. "They tell themselves, 'I'm not trained for this. I won't put to waste what I learned,''' Labajo says.

Community work wasn't part of Lariosa's training at MCU. But being a born-again Christian, he was active in the Campus Crusade for Christ and joined its medical missions. He worked in the city's slums and among tribal people in Mindanao.

When he decided to become a barrio doctor, his mother had no objections. (His father died before he finished medical school.) A native of the Malig Plain of Quirino, Isabela, Lariosa had hoped to be assigned to the isolated coastal towns of his province or to the Cordilleras. But the Leaders for Health Program was then focusing on Samar- Leyte and Surigao del Norte.

Nodora's family, however, resisted letting him go to Iloilo. "It was nervewracking," he recalls. "The family was taken by surprise. They had expected me to go to residency training. You know, white-collar, hospital setting."