With the doctor-patient ratio in the Philippines standing at around 1:33,000, Agutaya’s 1:13,000 is far from extreme. In its website, the Doctors to the Barrios program places the recommended doctor patient ratio at 1:20,000. However, it is the isolation of these islands, the low incomes, and the lack of facilities that render the residents particularly vulnerable.

On some days, Doc Li swaps the drone of his motorbike for the chug of a pumpboat to visit his patients. Thirty minutes away from mainland Agutaya lies the closest island village of Diit. Although a stiff breeze was blowing, it was a stunning day, the azure sky only exceeded by the deep cobalt of the sea, and bunches of cotton clouds extending all the way to the horizon.

The local village chief Wilfredo Favillaran eagerly greets the doctor as he comes to shore. Wearing a white shirt and shorts, Favillaran has a heavy jaw and deep frown lines on his face. His 33-year-old son Bryan has paranoid schizophrenia.

Doc Li admits that dealing with patients with mental illnesses is an even greater challenge in rural areas because of the lack of specialists.

“Kailangan kasi makita talaga ng psychiatrist, at ‘yun ‘yung wala dito. Kahit sa Cuyo, kahit sa Puerto Prinsesa wala talagang permanent na nagkokonsulta na psychiatrist doon. Kailangan pa talagang pumunta ng Maynila para magkaroon ng definitive diagnosis ng illness. Tapos ‘yung mga gamot hindi laging readily available,” he says.

(“They have to see a psychiatrist, and we don’t have them here. Even in Cuyo or Puerto Prinsesa, they are no permanent psychiatrists there that they can consult. They have to travel all the way to Manila to get a definitive diagnosis of the illness. On top of that, the medicines they need are not readily available.”)

Making matters worse, mental illness, and how to deal with it, is not easily understood by people with little to no access to medical advice and information. Disturbing stories of sick people getting chained and treated like animals abound. With patient and dedicated parents, Bryan is one of the luckier ones, the doctor says.

Getting medicine for him is a costly affair, requiring father and son to take the ferry to Puerto Prinsesa every three months to buy twice-a-day maintenance pills that cost 63 pesos a pop. But at least it works, Wilfredo says. Without the medicine, Bryan would become difficult and unpredictable. Before his son was diagnosed, Favillaran would seek the help of traditional healers in a desperate effort to cure Bryan. Sometimes, the instructions became quite outlandish.

“Hindi naman pala epektibo. May mga albularyo nga na linoloko ka pa. Itong bahay ko muntikan ko pang gibain, tinanggal ko na ‘yung atip, dahil sa hula ng albularyo, ito raw krus ang pagkapundasyon. Minamaso ko na nga eh! Sabi ng kamag-anak ko, uy wag, wag kang maniwala sa albularyo! Ayun natigilan ako. Ito ngang bahay ko may mga balete raw na tumutubo, ikot ako ng ikot, wala namang balete! Tapos pag-alis hingi ng P1,000, minsan P500. Grabe. Naibenta ko ‘yung isa kong bangka dahil dito!” Wilfredo says, his tone alternating between annoyance and amusement.

(“It wasn’t effective at all. There are even healers that just want to swindle you. This house of ours, I almost demolished it because of the say-so of a medicine man. I already detached the roof and was putting a sledgehammer to the walls, because he said our house was in the shape of a cross and that wouldn’t do. Then a relative said, ‘Hey, don’t go believing everything that healer says!’ So I sobered up. Another said there were unlucky fig trees growing around the house. A went round and round searching for them, but I couldn’t find a single one! And then when they leave, they will ask for P1,000 or P500. My goodness. I sold one of my boats for him!”)