Intermission

Sorry for the intermission, I am here in Oklahoma working hard. Oldtimers here say, “ some of us have to work to make a living”. I report for work at 4:45 am, take care of the paperwork and start endoscoping patients at 6:15 am.

When I arrived in the US, the Customs guy in LA cheerily told me, “Welcome home, Dr. Bautista”. This is a country where things work. Funny that you see multitudes of Filipinos at the airport as Immigration Officers, janitors, food concession employees, many others, we make the airport run especially during the graveyard shift. This is a nation that works, America the Beautiful, why won’t our country do the same?

Check out our headlines, the political intrigues surrounding the next Senate president, counting of votes in Maguindanao, whether we are lying about our GDP, there’s no real production involved, only gossip and chismis and nonsense.

So, let me work, make a little money. Gregory and Doc Lacsamana, we’re in the same continent. Life’s good. Let’s keep evolution and the meaning of life in the backburner. If we are going to change our country, we need to relax, take a couple steps back, think, keep independent.

We can change the World.

Let Faith Continue

A popular book these days is Christopher Hitchen's "God is Not Great: How Religion Poisons Everything". A very well written book that does not merely defend atheism, it also blames religion which he defines as organized superstition as mankind's true "original sin", the root of all mass killings and genocidal hatred, sexual perversions and the perpetual injustice that prevents the majority of people from enlightenment.

He totally dismisses any redeeming value in faith. “If one must have faith in order to believe something, then the likelihood of that something having any truth or value is considerably diminished” . As I said, the book is a dazzling read, crammed with historical and literary allusions but it reminds you of the old adage about being careful whenever you get what you wish for. Because for the truly poor, what will they have left if they turn completely materialistic and focused on their short lives? Auden began his poem Musee de Beaux Arts with "About suffering they were never wrong, The old Masters: how well they understood Its human position". What are we to do if we let go of our most dependable lifeline?

Horacio de la Costa claimed we have two jewels, our songs and our faith. Can our songs alone sustain us through all the suffering? As a betting people, we will be better off subscribing to Pascal's Wager. It may be the lazier pathway but I prefer to continue believing in faith because I am mortified to think about the hopeless consequences that atheism brings. So long as we continue to help others and do good and not commit evil in the name of our Faith, I don't see why we should stop believing.

The Long Count

Election Day was 38 days ago and the counting continues. If the votes in Maguindanao are counted, Miguel Zubiri, an administration candidate will win the 12th and final slot in the Senate. If the votes are not counted as per the Supreme Court petition of Aquilino Pimentel III, then Zubiri loses.

In most countries, this would be an open and shut case. Why even burden the Supreme Court with a seemingly simple question? Votes need to be counted because the foundation of a democratic system rests in the sanctity of every person’s vote that is expressed in every ballot.

Unless voting did not take place and election returns were fraudulently mass produced. This consideration is at the heart of the delay in the long count. Obviously, administration allies are frantically finding ways to justify counting what appears to be corrupted returns. Why won’t they for a change find some courage and proclaim Zubiri and dare the Filipinos to unleash a revolution?

Because this is how we deal with problems in our country. We don’t deal with them if we can and we resort to the long count. After 21 years, it’s only now that we’re slowly acquitting the Marcos cronies one by one. We still don’t know who killed Ninoy Aquino. We’re still waiting for the Erap Estrada verdict and Trillanes may already be our President by the time the prosecution rests its case.

Feudalism and oligarchies rely on the long count to remain in power. So long as those leading the dramatis personae are unchanged, waiting is just fine. Time is ever on their side.

This is why the conclusion to this little imbroglio is not that important. No big change is coming. You would have thought that since Pimentel’s father, Aquilino II was a victim to a similar scheme years ago he would have used all his powers as a leading figure in the Senate to forestall any possibility on such a fraud from being perpetrated upon his own son.

Time is on their side.

Cebu Pacific Airlines

Anyone who frequently flies with Cebu Pacific Airlines will nominate John and Lance Gokongwei for a Ramon Magsaysay Award (many many times referred to as the Asian Nobel). This upstart airline is truly making it possible for every Juan to fly. It also gives non-traditional politicians a chance to compete with those trapos with their own fleet of airplanes. Check out their deal: you can book your flight online using their extremely friendly website, print your ticket, ride in a brand new Airbus, potentially win one of their cheesy prizes through their onboard fun flight games and until a month ago, drink free C2 (a flavored drink). All for PhP 1600 ($32) one way to Bacolod. If it were not for the fuel surcharge and the various taxes the regular price would have been PhP 580 ($12).

They have 4 flights daily to Bacolod and the aircraft is often full. No frills. No newspapers, no coffee, no frequent flier miles. Minor inconveniences compared to the ease of planning your flights at any time of the day and you don't get charged for using your credit card (explanation: many establishments here pass the credit card transaction fee normally borne by the seller to the customer!).

The Gokongweis have a big hurdle in Government. Taxes and duties almost equal the airfare at times. The Manila Domestic Airport is a disgrace. Every departing passenger is made to pay PhP 200 ($4). Where all that money goes is a mystery because the airport surely does not betray any appearance of luxury. The food that can be purchased inside the lounge is overpriced and the entire male population is serviced by three (3) urinals. Like most government facilities, toilet tissue is a rare commodity.

The Gokongweis demonstrate that there are a lot of money-making opportunities even in a country with a struggling economy. Billions of dollars in profit may be realized in relatively honest fashion. During the Marcos dictatorship, the Philippine Airlines, "Asia's First Airline" was nationalized and conveniently used as a cash cow and private charter service by those who held absolute power. It was run into the ground until another Taipan rescued it.

Go Cebu Pacific!

The Milk Code

Breast has always been best. We even have a law for this, the Milk Code that was established to encourage mothers to nurse their infants for as long as they could. Now that the election is over, let’s see how many will raise cries of protest over the threatening letter sent directly to GMA by the head of the US Chamber of Commerce that pointedly reminded her of the employment, investment and trade implications that would result with the enforcement of new rules and regulations that will make it a little more difficult for giant multinationals to mislead the poorly informed.

Infant formula is big business worldwide. The Philippines is a tiny market for these big players (Nestle, Wyeth, Abbott-Ross, Mead Johnson) but money is money. In the US, infant formula is very expensive but 2 factors make them “sure buys”. The convenience it provides especially to working mothers and the direct support of the Federal Government in the form of food stamps (WIC program-Women with Infants and Children). Formula milk is not superior to breast milk. It will not make our kids more competitive in the future (education and healthcare will). As a matter of fact, formula milk kills children in our country because clean water fit for human consumption is a rarity in impoverished areas resulting in untold numbers of enteric infections. Likewise, in a desperate attempt to skimp and save, ignorant mothers purposely dilute the formula they feed their babies and unwittingly raise malnourished kids who possess among other complications under-developed brains and immune systems. Now you know why tuberculosis and pulmonary infections are so common around here.

Nursing babies is nature’s way of family planning. It is also the most effective manner to regain pre-puerperal measurements.

Powdered whole milk is a totally different issue. There is such an abundance of this product in other countries. There is no shame in asking for the enormous surpluses that the US, Australia and New Zealand have. Or in negotiating with these countries to let us purchase milk at a markedly reduced price. Instead of raising herds of cattle that will contribute to elevated levels of methane and require large amounts of feed, we should convince the people in these nations to share their largesse. Powdered whole milk is superior to instant noodles which is the dietary staple of the majority of our youth today. The protein from milk will spur the intellectual and physical growth of succeeding generations. This is one product I have no problem importing.

Musa Dimasidsing

Musa Dimasidsing a teacher in impoverished Maguindanao witnessed voting fraud that is common in the poorest areas of our country. He courageously volunteered to speak out against the cheating and he was shortly shot to death.

An overwhelming majority of our government employees are honest and industrious. They make very little money and their options are limited. Our teachers, enlisted soldiers and policemen are extremely underpaid and underappreciated considering the gravity of the responsibility placed on their persons.

So it is with particular dismay that I write this entry because our country appears to have moved on entirely, completely shutting out the sacrifice of one Musa Dimasidsing. Never mind that the election official in that area has admitted that certain certificates of canvass have been lost, and that there well may be reason to call for a failure of elections in that place, we have all come to accept these as never changing realities. What is deeply troubling is our collective resignation to the inevitable slaughter of decent public servants who, like many of us, were simply performing their duties. In any nation with strong institutions, every effort will be taken and every lead will be exhausted to find and punish the killers of Musa Dimasidsing. If the Commission on Elections cannot perform its duty as it expected Musa Dimasidsing to perform his, then there is no reason for them to continue acting to preserve the sanctity of our votes.

Humility

I had to pause and reflect upon humility yesterday. By chance, yesterday's Gospel was found in Matthew 5,13-16.

"You are the salt of the earth. But if salt loses its taste, with what can it be seasoned? It is no longer good for anything but to be thrown out and trampled underfoot. You are the light of the world. A city set on a mountain cannot be hidden. Nor do they light a lamp and then put it under a bushel basket; it is set on a lampstand, where it gives light to all in the house. Just so, your light must shine before others, that they may see your good deeds and glorify your heavenly Father."

We are all called to evangelize. We are all responsible to make the world a better place. Each of us must find the best way we can give back. There wasn't any boasting intended when I wrote about the University of the Philippines College of Medicine. I felt my pride in the institution was justified and I wrote it in my blog. I also called myself a prototype of things to come. Am I not allowed to sing paeans to myself in my house? If you can even call them paeans? But it was ungracious of me to flash a sliver of arrogance towards a guest even if I felt it was deserved and so my humble apologies (no sarcasm intended with the pun) to jdtl, md.

But humility? Come on, would any of you even consider descending into a political maelstrom with no reasonable chance of electoral success? When I referred to the campaign as a "humbling experience", I had in mind a picture of myself, a successful physician based in the US talking to market vendors in Davao, Cebu, Cagayan de Oro introducing myself and try hard to reach out to those I felt needed the most help. I did encounter a numbing dose of cynicism, incredulity, despair, resignation, skepticism amid the poverty and the unwholesome living conditions but what made the experience humbling and ultimately worthwhile was the hope most people continued to harbor that life would be better for their children no matter how unfavorable the odds.

My commitment to help improve the situation in whatever way I can has grown stronger. I am impatient and I think these are desperate times. I sincerely want our leaders to succeed and our country to rise but as the election of Sonny Trillanes demonstrates, regardless of the rosy economic numbers and hopeful forecasts, very few are buying.

How To Lower Drug Prices

As expected, Congress failed to pass a bill that would make medications less expensive. Apparently we are second only to Japan in having the costliest drugs in Asia. Our drug prices are higher by 40 to 70 percent compared to other countries in the region. The public was fooled into thinking that meaningful reform regarding the ridiculous drug costs was underway and a few members of Congress made a big, loud spectacle of throwing out some members of pharmaceutical companies from the session hall to demonstrate their independence, even if most of them knew the bill was so poorly crafted and loaded with defects.

Throughout the 90 day campaign period, I was given 3 minutes and thirty seconds of free national television exposure when I participated in a program that asked each candidate 3 questions. One of the three questions pertained to my stand regarding parallel importation of medications considering that my “sister was a lawyer for a multinational pharmaceutical company”. I was flabbergasted by the question because it suggested that I went home and left my medical practice to shill for a pharmaceutical company in the Philippines!

Now all this debate and talk about drugs being expensive involves a lot of idiocy. Cited all the time as an example is Norvasc, a medicine for hypertension, priced at P41.41 per tablet, instead of a possible cost of only P5.77 per 5-mg tablet if imported from India. Hypertension is the fifth leading cause of death in the Philippines killing over 300,000 people in 2004. I don’t understand why our government does not take the initiative to manufacture less expensive and almost equally effective alternative drugs like diuretics which cost something like P0.10 to manufacture? In the US, diuretics belong to the so called first line of anti-hypertensive medications. Why do we insist on Cheetos when we can settle on Chiz Curls? Another favorite drug here is Plendil which costs P21.82 a tablet instead of P2.69 if imported from India. I remember back in 1990 while working for the US Veterans Administration we were instructed to stop prescribing Plendil altogether and switch to generic nifedipine, a related calcium-channel blocker that was way less expensive. A popular drug for pain and inflammation is Ponstan which retails for P25 per tablet. If imported from India, the price plummets to P3.22. I don’t recall a single episode in 17 years in the US of ever prescribing Ponstan (mefenamic acid) because we always started with acetaminophen or Tylenol and made our way up to ibuprofen, naproxen. Much cheaper and very easy to produce. Importation is not the answer.

The government through the Department of Health must educate the public about the rational use of medications. We must not expect for-profit pharmaceutical companies to stop hosting educational symposia, or make donations to libraries or send physicians abroad to attend educational activities because these invariably influence prescribing patterns. We must begin becoming self-sufficient on anti-hypertensives, anti-tuberculosis medications, anti-infectives, anti-inflammatory drugs. We can’t expect drug companies to invest on a drug that will sell for P0.10 apiece. There is no profit here, this is why we have a government. We’ve done it in the past. Ilosone (erythromycin) was isolated from soil samples obtained in Iloilo (hence the appellation) submitted by Dr. Abelardo Aguilar in 1949. It remains the antibiotic drug of choice for penicillin-allergic patients.

Our Senate and House of Representatives do not have the wherewithal to shake the system. They have behaved like noisy purveyors of false hope. All I need to ask is “look where we are today?” If I become President, I will make an inventory of priority diseases that we can realistically control (hypertension being one of them) and direct the Secretary of Health to buy a laboratory that will be dedicated to manufacturing generic alternatives. Even if the savings from renegotiating our interest payments are not yet available, I will realign funding from many existing programs that are not performing effectively and believe me, there are many harebrained programs. Through a Barangay distribution system, we will offer the generic medications at cost to all hypertensive patients and offer free blood pressure readings as well (this is very easy with all the inexpensive automatic manometers around). Point is, this problem requires Executive fiat. Let's stop all this posturing and get to work.

Words of Wisdom

Rev. Peter J. Gomes is a Professor at Harvard University. Below are excerpts from his commencement address at Augustana College:

Around this time of year I have an annoying habit of asking people, like you seniors, “Do you have a job?” You resist answering that question, but I repeat it, “Your mother and I want to know, do you have a job?” By job we don’t mean simply something that gives you a salary; I think we really mean: “Do you have a purpose? Do you have a calling? Do you have a vocation?”

I want to suggest to you that whether or not you have a job, everyone has a vocation, and that vocation is to live a life that is worth living. The best advice I can give is that which St. Paul gives us in Romans 12, where he says to the likes of you, who all look alike from here, “Be not conformed to this world.” Do not join the throng. Don’t get lost in the crowd. Don’t be a part of the cookie-manufactured college generation, but stake out for yourselves some extraordinary, maybe even eccentric, piece and place of the world, and make it your own.

Release Crispin Beltran Now

Crispin Beltran is the 74 year old Anakpawis party-list representative who has been detained since February 2006. He is a lifelong activist who has committed his life to fighting for the rights of the poor. A few days ago, even the Supreme Court chided the government for continuing to harass Beltran by imprisoning him in a hospital over the flimsiest of charges. Beltran needs to be released immediately.

It is not hard to see why communism continues to flourish in our country even when the original Marxists and Maoists in China and the USSR are rapidly becoming extinct. Communism is a flawed economic model. It will definitely not work in our country. But just as we don't imprison our leaders for continuing to implement failed economic policies, we should also leave Beltran and his group alone as long as they pursue their goals with active nonviolence.

I submit that it is even more of a crime if we do not do anything at this time. If we pretend that we are on our merry way to achieving first world status in 20 years, if we continue to hope that our leaders will experience mass conversion and discard their corrupt and inept ways. Beltran rose from the ranks as a labor leader over more than 50 years. He has tirelessly fought for human rights, higher wages, trade disparities, disastrous debt policies.

Any rational person will understand why some groups resort to violence because it is a form of violence to allow and perpetuate a majority of our people to live under horrible and hopeless conditions. To many of us, we have run out of options. Nothing in what we see today is going to make life more bearable tomorrow. We cannot see the light.

But it would be a terrible mistake to go down the path of violence. I think even the most hard-core revolutionaries understand this. The rich will only get richer and the poor, poorer. We need to remain militant, progressive, demanding, educated, firm and nonviolent.

Release Crispin Beltran now.

The Prototype

I have always been proud of the University of the Philippines College of Medicine. When I entered the College in 1984 it was the only state medical school in a nation of 70 million. Competition to get into the school was terrific and acquiring stratospheric grades throughout the 4-year pre-med course fulfilled the fantasy of many obsessive-compulsive students. What made the school great was the quality of the students. The cream of the combined national genetic pool. The competition to remain in the school was even more intense. All in all an absolutely gratifying intellectual experience that lasted 5 years.

This year, 1000 applicants competed for 140 slots. In contrast, 15,000 applications were received for the 70 spots at the neighboring University of the Philippines College of Nursing. This certainly does not bode well as it demonstrates the vast transformation in priorities that occurred over the last 20 years. The brightest minds are seeking pathways to get out of the country ASAP. Intellectual development can be postponed for some other time and preferably in some other place but the main consideration is a quick exit. How can anyone blame all these hopeless youth? Much more how can anyone blame their hopeless parents who only want better opportunities for their children?

Recently, I listened to a member of the Nursing Board address a graduating class of 300 nurses. He began by detailing how noble the nursing profession was and proceeded to castigate the innumerable majority of their predecessors who had left the country. He then appealed to the young men and women to stay in the Philippines and help out in the medical crisis that was getting worse. I found his style most ineffective. When I was at that stage in my life all I could think about was how soon I could begin my life adventure. There was no speech that a stuffy official could deliver that was going to get at my conscience and prevail upon me to delay my plans.

The question is not whether our students should seek more training in other countries, it is how we can make them return and give back so much more than if they stayed behind.

And this is one reason why I have entered the dirty world of politics because most of our problems require political solutions. Our country is in terrible need of citizens who are not beholden to special interests and political blocs, who possess superior intelligence, who have had the opportunity to view the situation from a wholly different perspective, who have clear goals and plans for the future. There are thousands of such Filipinos all over the world. I am a prototype.

100 Years of Congress

Just finished listening to GMA's address before the House of Representatives on the occasion of the 100th anniversary of the Philippine Congress. She had barely arrived from China, the Vatican, Fatima and there she was congratulating one and all about the conduct of the recent elections. She extolled the booming economy and reported that the country was well on its way to achieving first world status in 20 years.

Now I don't want to sound like a spoilsport but I also got back from a tour of a public school and I must report that I could only see a faint glimmer of the promise that GMA was referring to with the sorry state of the school facilities that I saw. The kids were crowded into poorly ventilated rooms and had to share worn-out desks and very much used textbooks. The toilets could rouse a comatose patient with the fierce ammoniacal odor. The teachers, true heroes, appeared to be doing the best they could.

There is no way we will reach first world status with this set-up. A strong, relevant educational system is the cornerstone of any lasting economic recovery and it won't be coming out of this system we have today. We urgently need to pour money into the decrepit infrastructure including the acquisition of internet that will make it possible for our youth to be exposed to the advances in science and technology. I have maintained that making students read certain sections of the New York Times alone will greatly enhance communication skills. We must double or even triple the salaries we give to our teachers. I am convinced our country has not fallen off the precipice mainly because of the sacrifices of these heroes. They are working against great odds.

We urgently need leaders who will inspire the people to become more productive and to become more active in their communities. We need leaders with more imagination. Raising taxes alone is clearly insufficient.

The faint glimmer I witnessed was in the bright eyes of the skinny students who remained enthusiastic despite the depressing surroundings. We cannot fail them.

Back to School

Back in Bacolod, we didn’t have any internet access for quite some time. Customer service based in Manila kept on promising assistance that finally showed up after close to a week. Since newspapers come in only after the first flight arrives from the capital and are available in limited quantities we lived in a virtual news blackout. Proved to be quite a relief actually. We played all the golf we wanted and we resumed our reading regimen.

The kids are back to school. I am very aware and very distressed that throughout the country, a new batch of teenagers are unable to continue with their schooling and have become part of the underemployed masses. For the overwhelming majority of these kids the promise of a secure future has been permanently dashed. I personally know of a 15 year old girl, fourth in a family of 6 children who was volunteered by her parents to work as a domestic helper. She needed to start contributing to the family finances. On her first day on the job, far from her family who lived in a town 30 kilometers away, she asked for a small advance to buy soap and toothpaste.

This is the Philippines that posted a 7% growth rate for the first quarter, where the stock market has never been stronger, where billions of dollars in investments are supposedly pouring in. There is a tremendous disconnect that we must not ignore any longer because most Filipinos live in conditions that may be labeled as desperate by world standards. All you need to do is live in a more progressive country for a few years and you will understand perfectly what I am talking about. It will resensitize your senses to experience revulsion once more to many daily realities we treat with nonchalance.

It was President Ramon Magsaysay who paraphrased the adage that those who have less in life should have more in the law. This would exemplify the concept of preferential option for the poor more than anything. Oral contraception has very little to do with it and nearly assumes irrelevance next to the powerful and abundant testimonies of what evil consequences poverty and corruption bring. Next to all these personal tragedies, we who are more fortunate should use all the power that we have to lend more dignity to as many lives as we can. Anyone searching for a never-ending task need not look any further.