Kimberly Regala-Ferrer thought she was having an asthma attack in December 2024 when she experienced difficulty in breathing. Then, she suddenly lost weight and had dry skin, which she believed was due to her recent childbirth.

Later, in January 2025, the mother of three had chest pains and got easily tired.

“Parang namimilipit na tinutusok — basta masakit talaga. ‘Yung pinagpapawisan ka. ‘Yun pala inaatake na pala [sa puso],” Kimberly told Rappler. “Tapos hindi na ‘ko makalakad; kahit two meters hindi ko na kaya o one meter…. Hirap na hingal.”

(It was like twisting, stabbing pain — it was really painful. I was sweating. It turned out, I was having a heart attack already. I cannot even walk a meter or two…. I was exhausted and out of breath.)

She went to a doctor — a general practitioner — in her hometown in Malasiqui, Pangasinan, who diagnosed her with heart enlargement. She was told to go to the hospital for blood transfusion because of her low hemoglobin level.

At a hospital in neighboring San Carlos City, another general practitioner had the same diagnosis: she had heart enlargement. On top of that, the doctor said she also had goiter, and that her days were numbered. Kimberly refused to accept her predicted fate and sought a second opinion, this time from a cardiologist in her hometown who said she had rheumatic heart disease. The cardiologist said she had a heart valve defect and recommended that she seek treatment at the Philippine Heart Center (PHC) in Quezon City, which had advanced facilities and equipment.

During her checkup days, she would leave Pangasinan by 1 am and reach PHC around 5 am. Her doctor often arrived in the afternoon and started checkups by 3 pm. Her checkup would usually end at around 5 pm or 6 pm. She would then take the long trip back to Pangasinan.

While waiting for her doctor’s appointment, she would squeeze in getting guarantee letters from lawmakers to ensure that her bill would be paid. Kimberly used to be an online seller but she had to stop when she fell ill. Her husband is a freelance singer. They have three children, a nine-year-old and two-year-old twins.

Asked about the difficulties of getting treatment far from her home, Kimberly shared: “Mahirap. Ikaw na nga ‘yung pasyente, hingal ka na nga, ikaw pa ‘yung naghahanap ng pampa-opera mo.”

(It is very difficult. You’re the patient, you’re exhausted, and you’re also the one looking for funds to cover your operation.)

She said she could not afford to travel with another family member because it would cause a further strain on their finances. “Kung magpapasama din ako sa kanila [family] — hindi naman kami mayaman [o] mapera para mag-dalawang tao na pamasahe. So, sabi ko sa kanila, ‘Kaya ko ‘to,’” she said.

(We are not wealthy enough to afford a fare for two persons. So, I told them, “I can do it alone.”)

Kimberly’s determination to get well finally paid off when she had surgery at the PHC in December 2025. Since then, she said, she felt better and some of her symptoms had begun to ease.

Asked what would have happened to her if she chose to focus on the financial and logistical challenges and ignored her health condition, she said: “Baka wala nang pag-asa. Aantayin ko na lang kailan ako mawawala kasi para gumaling ako sa sakit ko ay kailangan operahan. Kung aasa lang ako dito sa amin, sa Pangasinan, wala po. Lalo na severe na po case ko need na operahan.“

(I would be hopeless. I would just wait for my death because to get well, I need surgery. If I just relied on what we had in Pangasinan, there’s nothing. Especially in my case which is severe, and I need to get surgery.)

Lack of cardiologists

Kimberly’s case highlights the challenges faced by people with cardiovascular disease in the Philippines. On top of the lack of adequate medical facilities for treatment outside highly urbanized areas, there is also a shortage of cardiologists in the country.

Data from the Philippine Heart Association (PHA) showed that the national ratio is one cardiologist for every 44,000 Filipinos, but access would still depend on one’s location.

According to the PHA, the lack of facilities is among the reasons why there is a shortage of cardiologists especially in the provinces.

The PHA said 52% of its nearly 2,500 cardiologist members are practicing in Metro Manila or a ratio of one cardiologist for every 12,000 Filipinos in the capital region. The remaining 48% are scattered elsewhere. In the rest of the country, there is only one cardiologist for every 80,000 Filipinos.

The situation is even bleaker in provinces without a single cardiologist, the PHA said. These are Ifugao, Mountain Province, Kalinga, Apayao, Romblon, Marinduque, Siquijor, Basilan, Sulu, and Tawi-Tawi.

Preference to serve in cities

The PHA said cardiologists prefer to practice in highly-urbanized cities where equipment is available like those in Metro Manila, Cebu, and Davao.

PHA president Dr. Walid Amil is hopeful that the creation of regional specialty centers will encourage cardiologists to serve in the provinces.

Under Republic Act 11959 or the Regional Specialty Centers Act, the Department of Health is tasked to establish specialty centers in DOH hospitals in every region.

The law defines specialty centers as “a unit or department in a hospital that offers specialized care addressing particular conditions and providing specific procedures and management of cases requiring specialized training and equipment on a specific specialty” such as care for cardiovascular disease, cancer, lungs, kidney, and brain.

“Hopefully, isa itong [DOH program] magiging attraction sa mga graduates natin na [cardiologists] na to go into these regional heart centers para ma-spread out ang distribution ng ating [cardiologists],” the PHA president said, raising the need to decentralize cardiologists.

(Hopefully, the DOH program would encourage our cardiologists to go to these regional heart centers, to spread out the distribution of our cardiologists.)

The Philippine Information Agency said the government has established 33 specialty centers in 2023 and 41 as of the third quarter of 2024.

Years of training

Amil said another factor for the shortage of cardiologists is the long training period. He said that those who want to pursue cardiology would have to spend six more years for training after they get their license from the Professional Regulation Commission.

A medical-degree graduate who earned a PRC license and wants to pursue cardiology has to take an internal medicine or pediatrics specialty training for three years, then another three years for a cardiology subspecialty fellowship.

Some doctors who completed their specialty training do not venture into a subspecialty anymore.

Amil said doctors who have families to feed are discouraged to train for cardiology. While those who are on a cardiology fellowship get compensation, its not enough to sustain a household.

Work-life balance

Another reason for the shortage, Amil said, is the preference for a work-life balance.

“‘Yung iba na ayaw nang ma-toxic, ayaw nang mag-duty [nang matagal]. Gusto nila work-life balance. Isa ito sa nakikita namin na [rason bakit] hindi na sila nagpe-pursue ng further cardiology or other subspecialty training,” he said.

(Others do not want a toxic environment or to go on duty for long hours. They want a work-life balance. This is one of the reasons that we have observed why they do not pursue cardiology or subspecialty training.)

Amil said trainees often spend most of their time in hospitals during fellowships.

He noted there are job opportunities for general practitioners with a huge salary. This pushes them not to undergo further training and just work immediately after acquiring a PRC license.

Overworked cardiologists, lack of patient access

Based on PHA’s observation, there are cardiologists who are exhausted due to a swarm of patients, particularly in provinces where there is only one or two cardiologists.

“Ang impact naman niyan sa cardiologist, siyempre, sobrang busy ng kanyang lifestyle, sobrang stressful siya. In some cases naman, siyempre, kung madami kang pasyente, ‘yung concentration mo, puwedeng maapektuhan ‘yung quality of care mo doon sa pasyente kasi nga parang mabilisan na lang just to accommodate all these patients,” Amil said.

(The impact is that cardiologists get such a busy lifestyle and such a stressful life. In some cases, if the cardiologist has a lot of patients, the concentration and the quality of care given to the patient may be affected because things are done quickly to just accommodate all the patients.)

On the part of the patients, there are some who are forced to travel far just to get professional medical attention due to the lack of facilities in far-flung areas, PHA said. But there are also patients who decide to forgo treatment because of the absence of specialists and facilities in their areas.

“So, talagang tumataas ang incidence ng death or namamatay sila doon sa area na ‘yun in comparison na madadala sila sa may mga [cardiologist] and may mga advanced cardiovascular facility,” said Amil.

(The incidence of death in remote areas is high in comparison to areas where there is a cardiologist and advanced cardiovascular facility.)

Amil added that having regional specialty centers with advanced facilities and equipment would be a vital for patients for relatively accessible healthcare, instead of traveling to major cities.

To further boost the number of cardiologists in the provinces, the PHA said they will talk to cardiology institutions nationwide to prioritize fellowship candidates from provinces without a cardiologist and negotiate a return-of-service arrangement with the trainees to serve their home regions.

For provinces without a cardiologist, the PHA is forming sub-chapters in which doctors, not necessarily a cardiologist, would be invited as an associate who will conduct lectures and implement the group’s programs.

‘One cardiologist for every city’

The PHA has an ambitious target: one cardiologist for every city in the country. The question is whether young doctors can be enticed to pursue cardiology. If not, their ranks would shrink further, Amil said.

“The main impact would be lalong tataas ang ating number of patients na magkakaroon ng sakit sa puso at saka mamamatay sa sakit sa puso kasi kumokonti ‘yung number of cardiologists,” Amil said.

(The main impact would be the greater number of patients who have heart disease and deaths because of the decreasing number of cardiologists.)

Philippine Statistics Authority data showed that ischaemic heart diseases accounted for 40,532 deaths in the Philippines from January to April 2025.

The PHA advised the public to take care of their heart health by having a proper diet, regular exercise, and consistent check up. – Rappler.com