Senator Tom Coburn, MD

Tom Coburn, MD is one of two US Senators who represents Oklahoma. He is a very conservative Republican and I agree with him on very few issues. He sees the world in a markedly different way from how I see it. But this does not take away my deep respect for Coburn who continues to practice medicine, free of charge during the weekends when he is away from Washington. Before he became a Senator, he was a congressman for 3 terms and because of a previous pledge to limit his service to 3 terms, retired to his clinic in Muskogee, Oklahoma when his 9 years were up.

Coburn is a straight shooter. He may have some idiotic ideas but his commitment to his country is beyond reproach. As a freshman Senator, he challenged a 40-year veteran Senate president pro tempore Ted Stevens on his pork barrel project that was famously known as the “bridge to nowhere”, a 200 million dollar bridge that would connect fifty people to a coast somewhere in Alaska. When it came to a vote, 82 Senators chose to support Stevens and only 14 had the courage to oppose what was clearly an abusive exhibition of political power. He is convinced that the longstanding politicians who have inhabited congress do not possess the will to enact revolutionary changes. Coburn is horrified at the 9 trillion dollar US debt (for once, we in the Philippines can count our blessings). He has a personal crusade to make the American people aware that the succeeding generations will be responsible for dealing with this problem and every time money is spent irresponsibly, the debt only zooms higher.

We need politicians like Tom Coburn. Part-time legislators, who do not depend on politics for their livelihood and unafraid to tangle with the traditional old-timers whenever they exercise their oversight responsibilities.

Our Mission, Stated

We love politics here. We live politics. We easily forgive our politicians. Yesterday, we held our version of the US State of the Union Address, what we conveniently refer to as our SONA (State of the Nation Address). Classes were suspended in many schools in Quezon City and many workers took the day off in anticipation of rallies and marches that could hopelessly gnarl-up traffic. The mood was festive at the House of Representatives. Our lawmakers and their spouses and parents were decked in the finest native couture. A new Congress was about to be inaugurated and fearless leader Gloria Macapagal Arroyo was going to give an hour-long speech.

If what she enumerated was all true, how come millions of Filipino children are hungry and worm-infested and malnourished and receiving inadequate, substandard education? Why is national productivity so wretched? Why are human rights wantonly abused? Why don’t we feel secure and why do we fear getting kidnapped? Why are there so many loose firearms and bodyguards?

Because we don’t have a leader who will inspire us to pay our domestic helpers more, who will make us pay our fair share in taxes, who will convince us to stop smoking and plant trees, who will make us conserve electricity, who will inspire us to walk instead of ride short distances, who will make us become more involved in civic programs, who will make us clean our surroundings, who will make us obey traffic rules, who will appeal to our overseas brothers and sisters and ask them to double if not treble their remittances for 5 years, who will have a realistic and courageous understanding on how to manage the gargantuan debt, who will have a clear vision for the future, who will serve for one term only.

We won’t be on our way to reaching First World status if all we do is quibble about who gets to be Speaker (again). As if De Venecia hasn’t been given the opportunity to do good for our country. I tell you most solemnly, the peaceful revolutionary change we all hanker for will not emanate from 5-time Speaker Jose De Venecia. Nor will the second longest-serving president pull it. They and most of the rest of that tired and traditional, ineffective and spent bunch of preening politicians will not be able to do it. They no longer have the energy and the imagination and most importantly, the moral force to rescue our country.

Since we all love politics anyway, we ordinary citizens must rise and take our beloved Philippines back. We cannot depend on anyone else but us. We have talked and criticized enough, complained and analyzed enough, now is the time for us to act. United, we will be able to convert our “problem” of overpopulation into our greatest asset, 80 million pairs of hands working together for the common good.

Negros Island

Anybody who wants to see gorgeous topography needs to check out northern Negros Island. From Bacolod you head north and follow the curve past towns named Cadiz, Calatrava, Toboso before you hit San Carlos City which is separated from the island of Cebu by the Tanon Strait. You make your way back to Bacolod by cutting through the mountains ending in a town called Murcia. The Spaniard who originally designated these names probably was reminded of the old places back in the Iberian Peninsula.

You will see chocolate hills, rice terraces, mountain peaks and promontories with spectacular views of the azure sea, pine groves…. I was amazed by the scenery. The land was mostly undeveloped, there was no cellular phone signal and there were long stretches of highway under repair. There were quite a few buses overloaded with people clinging tightly all the way to the rafters.

All the 7100 islands of the Philippines put together would be as big as Arizona but when you compute all the coastlines that demarcate each island you will come up with a figure that will dwarf the combined coastal area of the continental United States. Discovering yet another beautiful area in the country fills me with hope for better prospects in the future.

But I spoke with a former landowner who was forced by the agrarian laws of the land to “sell” his farmland at a much reduced price to the tenant farmers. In 5 years, due to lack of support and the inability of the farmers to purchase seed, fertilizer, pesticides, the farm had become unproductive. The land was pawned and idle. I spoke to those who had farmed the land and who were now reduced to planting a tiny amount of crops that was barely enough for their own needs. They were smoking cigarettes a lot more and drinking rum and looked forward to those fiesta days when they would slaughter, kaldereta-style, some of the goats that kept the grass trimmed. This was not exactly a bunch brimming with hope.

Point is, there is much beauty surrounding us and the climate is gentle and the soil is rich. Have we become spoiled by all these blessings? Is this what the absence of struggle brings? But will industrialization and more money and more material things bring happiness and peace and contentment? I’d like to see the kids get better educational opportunities. I’d like to eradicate the roundworm infestation that is prevalent in these environs. I’d like to see less cigarette-smoking and more tree-planting. I’d like to see farm to market roads in better condition.

If you have a chance, visit Negros Island.

Jump

Just when you think all is lost with Philippine education, you watch a rehearsal where 50 first graders dance to the tune of the Pointer Sister's "Jump". Boundless energy and overflowing enthusiasm after a full day at school. 6-year olds still attend 8-hour school days and they are taught Math, English, Filipino, Civics, Music, Religion and PE. All this in a branch Academy in Bacolod City that had its beginnings in 1906 when 5 young missionary sisters of the Order of St. Benedict from Tutzing, Germany came over at the request of the Manila Archbishop to educate poor children. There are very few poor kids in this school. While tuition can be waived fully, peripherals in the form of books, supplies, transportation, uniforms, board and lodging still cost a lot of money, way out of reach of the majority of the people here. Friends say the quality of private school education in the Philippines has also deteriorated based on the caliber of the graduates they interact with. I went around this little campus (not that tiny compared to Oklahoma standards) and I was impressed with the facilities, spartan but functional, the teachers seemed happy to be doing what they were doing and the students appeared eager to learn.

Education is all about building a solid foundation that will produce lifelong students with open and inquiring minds that, upon meeting the world, will burst in a fabulously productive chemical reaction. We still have a lot of dedicated teachers and we now have the internet to exploit. The fundamental ingredients remain. We can still make the jump.

Pathways to Leadership

I was asked to give the closing remarks at the Alejandro Melchor Jr Foundation sponsored Young Leaders’ Conference. Cadets from the Philippine Military Academy, the 10 outstanding students of the Philippines, Ayala scholars, leaders from various schools were represented. Captains of Industry and former high ranking government officials spoke to the participants in the morning. I was all alone with the students in the afternoon.

My principal pitch was we heard from the old men in the morning, honorable, well-meaning men who did their best but the country was clearly not doing well. Our generation had to do better and we needed to find a different way. The heroes in the great myths always chose untested courses. Following the same path always spelled disaster. We have the benefit of hindsight and we shouldn’t blow our chance to try other methods. I impressed upon them my ordinariness. I wasn’t one of the 10 outstanding students, nor was I the class president or valedictorian. I simply hope to spur others to become more involved in the political discourse taking place in our country. We cannot afford to stay in the sidelines and allow our overstaying traditional politicians to continue lording over all of us.

I quoted Alejandro Melchor: “The highest calling next to serving God is serving one’s fellow man.”

Politics in the Time of Dengue

Doctoring in the Philippines is so different from doctoring in the US. You never run out of patients who urgently need to be seen by a physician here in the Philippines. As soon as you set-up shop and people find out you don’t charge, the patients are endless. And we are talking about very ill patients, resulting from years of neglect. Those who are most in need of medical attention are also those who cannot afford to pay anything. You can prescribe all the medications you want and you can order all the tests you feel are essential but most of the time nothing will get done. The patient will continue to get worse and your helplessness will frustrate you into a rage unlike anything you’ve felt before especially if the patient is 4 years old.

Dengue hemorrhagic fever is Grand Rounds material at the Harvard Medical School. Over here, the disease is so prevalent insect repellent takes on the aura of the Salk vaccine. Many kids die because we don’t have enough platelets to transfuse before they bleed to death. I suspect that many fatalities are not recorded because fever in children is very common and many are simply found dead in the morning.

If you see the squatter colonies that dot the country, you won’t have a hard time understanding why dengue is such a common killer. People live ON cesspools. Fetid, stagnant water is everywhere. Mosquito-breeding is an industry. But look, these people have a right to housing and they can be relied upon to vote for those who protect their rights, or at least those who promise to protect their rights.

We need politicians more than we need doctors. What good does a right diagnosis give when you can’t treat it anyway? We have one, big, all-encompassing diagnosis in our country today and it is that our leaders have failed us and they continue to insist on treading down the same failed approach to solve our worsening problems. Do our statesmen have anything to be proud about? All this jockeying over the senate presidency and all this posturing for the Presidential elections in 2010 almost seems humorous next to the dengue outbreak. It has been transformed into a ridiculous race with the prize being who gets to screw the country next?

Erap Estrada

Former President Joseph “Erap” Estrada has been in jail since he was deposed 6 years ago. He stands accused of plunder, a capital offense and the verdict is expected any day now. Estrada remains very popular and continues to be seen by many as the true friend of the poor. Even if Estrada clearly enriched himself while in office he will most likely be acquitted or immediately pardoned in the remote chance of a conviction due to the upheaval that will follow if he is punished. That’s how justice is in the Philippines.

Erap should be accused of squander. He had that rarest, historic opportunity to do great things for the country and he royally blew it. He would gamble with friends until dawn and he irresponsibly left the affairs of state to all sorts of characters and political operatives. One quality a developing country can’t afford in a leader is sloth. Whatever their deficiencies, Cory, FVR and GMA were all hard workers. Estrada on the other hand wasted his enormous political capital because he simply didn’t care. How else do you explain behavior that ignores healthcare and education while continuing to lead a reckless life of debauchery? He continued to see his many mistresses on a round-robin system while children all over the country were becoming stunted from chronic malnutrition. He continued gambling and drinking while the educational system deteriorated. He is said to have sired another child while under detention.

Many will attest to the extraordinary charisma of Erap Estrada. Many will swear that you will never meet a more amiable person than Estrada and I believe them all. It only makes Erap Estrada even guiltier of letting his country down.

Our country invested a sacred trust in Erap Estrada and he clearly did not deliver. I don’t think neither remorse nor regret is punishment enough.

Homecoming

I attended the Medical School homecoming for the first time because I wanted to start meeting people. After all, it will never hurt to know a few more doctors. There was an incumbent Senator, all the way from Manila who wangled an invitation and was seen vigorously schmoozing.

Every meeting has a Continuing Medical Education portion that allows participants to claim part of the trip as a tax deduction. One topic dealt with telemedicine, technology that I am very familiar with considering I practiced in a rural corner. At 1 in the morning and you would be called to see a trauma patient, you would invariably “send” the x-ray studies to Amarillo, TX for the radiologist to give a provisional reading. We would physically send the films the next day for a final diagnosis. That was 10 years ago. Today, it would be cheaper to “send” studies to India because we don’t use film any longer. Radiological studies are digitized into compact discs. For other specialties, it has become vastly easier to send the entire medical record of a patient to any specialist anywhere in the world for another opinion.

An older physician asked the doctor from the Philippines who was presenting the topic why we couldn’t hire more physician assistants and nurse practitioners to staff the thousands of unmanned Barangay health centers. Those of us in the audience who knew the reality in our country were flabbergasted. Was this guy from another planet? We don’t have PA’s and NP’s because anyone with these skills would have left the country a long time ago. We don’t have a problem with diagnosis in the Philippines. We don’t have the resources to treat diseases.

The UP Class of 1989 had a reunion one evening. After 17 years, I saw my group-mate in anatomy. He was now a Jesuit priest. He was peppered with questions regarding ethics and morality the entire evening. I also met an ophthalmologist classmate who had practiced in the hinterlands of Mindanao for 13 years until she decided for reasons of personal safety to migrate to the US as a registered nurse. Nothing dishonorable whatsoever in her decision. She had freely given her time and talent but was regularly showing up in the list of potential kidnap victims.

How to harness this large group of doctors most of whom earnestly want to give back to their country? How to effectively utilize the combined resources at their disposal? We all want to help.

7 7 7

My 10 day visit to the US ended at 4 this morning. We could have arrived earlier but the airport was closed and hence we had to spend some extra time in Vancouver. I tried the Las Vegas-Vancouver-Manila route for the first time and I wasn’t disappointed. The flight was 18 hours long but at least I didn’t have to change planes. I do have many things to write about and I will begin from the most recent.

Yesterday was one of the hottest days in Las Vegas history, 116 degrees Fahrenheit. You couldn’t stay outside for long. 4 hours before the flight, there was already a lengthy queue at the Philippine Air Lines counters. What distinguishes a flight to Manila is the presence of the ubiquitous Balikbayan boxes crammed with stuff and these boxes always weigh 70 lbs, the maximum allowable weight. If you were to x-ray these boxes, you will find many cans of corned beef and Vienna sausage, bars of Ivory soap, seasonal candy purchased the day after the event, shampoo, towels, Pringles potato chips, athletic shoes, clothing from Ross or Marshall’s or TJ Maxx, generic vitamin supplements, Splenda, used household appliances (particularly the recently replaced DVD player), hair color, toothpaste and deodorant. Returning female seniors are particularly adept at this ritual. And so even if it takes longer to check in and the counters are perennially crowded, it has always been a source of comfort to be in line with kababayans. The chatter becomes overwhelmingly Tagalog and everyone is just happy to begin the arduous trip home. No mistake here, no matter how long you’ve stayed away, regardless of the color of your passport, everyone’s homeward bound.

Amid the chaos, your faith in our simple ways becomes stronger. Like ants we are prepared to return various goods and sundry material transported via giant container cargo ships back across the Pacific box by Balikbayan box. I find this trait so admirable because each box is an amalgam of months of flea-market shopping, garage sales, K and Wal Mart specials. We anticipate the joy and grateful acknowledgement of the intended recipients back home with every shopping mission. We become united.

Hadn’t heard it in a long time but the main cabin erupted in cheers as our plane touched down the Manila Airport. We were all just glad to be home.