Monday, March 31, 2008

At A Crossroads


I am writing my entry to the blog carnival from Los Angeles. My 4 children are happily visiting their birth country after staying and studying for 2 years in the Philippines. This is just one of the many crossroads in my life.

Living a full life is similar to going on a journey. Medicine was never an end for me. Early on, I didn’t decide on becoming a surgeon or an obstetrician or an infectious diseases specialist. I decided I was going to begin living an autonomous life as soon as I graduated from medical school. I never bothered to apply for residency training in the Philippines because I could not bear the thought of continuing to depend on my parents for financial assistance after going to school for 22 straight years. It was America or bust.

I have always looked at challenges and adversity as opportunities for growth. The county hospital in Brooklyn, NY where I trained had more than a 90% AIDS caseload. Because there were very few US medical graduates willing to take the risk, I was able to receive superior medical preparation that enabled me to take on future challenges with confidence and competence. I trained at a time when we had to draw blood ourselves, wheel patients to x-ray, before the famous Bell Commission reduced the working hours of resident physicians--when it wouldn’t overly bother us to admit 12 patients on a call night and work 48 hours nonstop.

I look back and I am grateful. What would now be considered illegal and cruel punishment turned out to be a very effective way to acquire skills that would be very useful later.

After Brooklyn, private medical practice was a breeze. Because I entered the US on a J visa, I was required to “serve” a medically underserved area for 2 years. Guymon, Oklahoma with a population of 10,000 became home for more than 10 years. When I began, many patients would not even consider a “foreigner” to treat them. I know this because in the course of my stay, many of my patients would confess to this initial reluctance.

I never missed a Saturday clinic in 4 years. My home number was listed in the phone book and because I was available at all times, my wife and I would see up to 130 patients each day. It didn’t bother me that all that action in New York was so far away and that the nearest mall was 2 hours by car in Amarillo, Texas because I was looking towards another crossroads.

I grew up in the traumatic period of Martial Law. I still can’t understand how some people can long for the return of those days. It was terrible because the vast majority of us were afraid to fight for our freedom and dignity as human beings. Even then, I was painfully troubled by the horrible poverty that alienated and destroyed so many Filipino lives. I always dreamt of seeking my fortune elsewhere and return like the Count of Monte Cristo, vastly more prepared and equipped to help change a hopelessly corrupt system and way of life.

We doctors see a lot of dying in our business. This comes with the territory. We are reminded too often that at the end of our lives, it won’t be the amount of money we stashed in the bank, or the number of vehicles parked in our garage, or how many kids we put through Ivy-league institutions…. We should know better, that our brief lives will be measured by the service we dispense to the less-fortunate; and without a map and without a compass, this is what should guide each one of us through these crossroads.

Wednesday, March 26, 2008

Fiesta Days

Since the revelations regarding the almost-consummated $135 million bribery scandal, many of our traditional politicians have been in very good spirits. Each time damaging information would be divulged, their personal share in the ever-expanding largesse being freely distributed would appreciate.

Small proof of this would be the many pages of expensive paid advertisements extolling support for the way politics is conducted here, emanating from all these groups of Governors, Vice Governors, Mayors, Vice Mayors, Councilors down to the lowliest ward leaders. Money, meant for education and healthcare and food is flowing.

The rest of us are indignant. We simply want the truth. We want truthful and direct answers. But we are not getting any. The investigations will continue. Many of these solemn and self-righteous scumbags will continue posing and preening. And there will be more “Unity Walks” and photo opportunities celebrating the strength of our political caste system.

The Show will go on.

Tuesday, March 25, 2008

Cory's Colon Cancer

Very sad news indeed that Cory Aquino has fairly advanced colon cancer. I have been screening for colon cancer since 1994 and I have been telling everyone that they need to get a colonoscopy when they hit 50. As a former president and as one of the very few living Filipino heroes, Cory should have been scoped many years ago, it would have made sound medical sense and she would have provided an example for the rest of the country to follow. But now it may be too late.

Colon cancer enabled me to return to the Philippines. More important than the income I derived from performing many thousand colonoscopies was the singular lesson I learned from the diagnosis of the disease: that we must all die sometime and that at the end of one’s life, we will measure our lives by the amount of service we were able to give others.

To me, Cory Aquino is the greatest living Filipino. She is a shining representative of the heroic possibilities that a Filipino can possess. When duty called, she did not hesitate to make the necessary sacrifices. She did her best and she remained incorruptible long after she left office. Her integrity is unquestioned.

I join everyone in praying for Cory. Not that she has anything to fear. She has lived a pious life. She has given far more than she received.

Friday, March 21, 2008

Reflection on Good Friday

It is historical fact that Jesus was crucified. That he rose from the dead is based on the testimony of certain persons but there is no dramatic account of the dead and crucified Jesus stirring back to life. How did this death and seeming ignominious end begin a movement that continues to grow and change the way people of vastly different persuasions live?

It began with the example set by Jesus who proclaimed ‘Let your light shine before all’, more than a thousand years before the invention of the printing press. Jesus was sure that the singular example of his life was going to change the world. His example was not about words that would convince, inspire, motivate but rather about doing good in a visible way, ‘so that others, seeing your good works, may glorify your father in heaven’.

How could the message of his life-example change people in the Philippines, Nigeria, China, Korea, the US after 2000 years when there is not even a common language that unites all these people? Helder Camara is a Brazilian Bishop who instructs his catechists, ‘Sisters and brothers, watch how you live. Your lives may be the only gospel your neighbors will ever read.’

For the gospel of Jesus to spread, we are all called to witness every moment of our brief lives. To live in a way that our lives would not make sense if God did not exist.

Tuesday, March 18, 2008

My Message to the Graduates

I’ve been back home just a few days when requests started to come in, asking me to speak at commencement exercises. Unfortunately, I won’t be staying long because I am bringing my whole family to the US shortly after their classes end tomorrow. My daughters are excited to return to the lives they left 2 years ago.

I have to be back in our clinic to take care of business. Working without your family nearby, regardless of the compensation is brutal. Even with Skype and inexpensive direct dialing, the sacrifice is enormous. I think of all those millions of Filipinos, stuck in the deserts of the Middle East who would look forward to a brief phone call every month or so because of the expense that could have been part of the regular remittances that their families back home had grown to rely upon.

But I would have to emphasize this to all you graduates, that all is not lost. Most of us Filipinos continue to do our duty quietly every day. We know what needs to be done, we are painfully aware of the sacrifices that have to be endured. We have to do what we have to do.

How I would personally prefer to go around the country talking to the youth, the various citizens groups just like a true, traditional politician but I wouldn’t be setting a good example to my children. I don’t want them to see me transform into one of these unproductive trapos who talk and talk and become experts in living off this abominably unfair system.

All this excitement about the economic gains that our country has achieved needs to be placed in the proper perspective. Gross domestic product is the sum of our combined personal expenditures (which accounts for 70% of the GDP), government expenditures, investments and exports minus our imports.

Since 1985, personal expenditure was estimated from the results of a survey among 50,000 families inquiring about their income and expenses. These figures would closely correlate each other until 2001 when personal expenditure estimates greatly outpaced survey results. Two possible explanations: to make our GDP look better, we fudged the numbers in the finest Filipino accounting tradition or, a more plausible explanation was that the $14.5 billion in remittances that overseas Filipinos sent last year was significantly understated.

In terms of investments, the Philippines is at the bottom of the list in attracting foreign direct investment among the 6 major economies in Southeast Asia. Singapore attracted $36.9 billion, Vietnam $11.3 billion, Thailand $10 billion, Malaysia $9.4 billion, Indonesia $5.9 billion. We got $2.5 billion.

While previous administrations had higher investments and expenditures, our economic figures are much rosier today because based on the numbers supplied by our Bureau of Customs, we are importing much less. Are we to believe that we are importing less oil, less rice, less electronic goods, less vehicles and so on? Or is it because of the phenomenon most everybody is aware of, namely rampant smuggling?

So our economy is doing better not because of the honest example and leadership of Gloria Arroyo, nor is it because of the legislative prowess of her 2 sons and brother in law. There are very few takers when it comes to investing in our country because of our reputation for unbridled corruption: the powerful can buy elections without fear and convicted plunderers are promptly pardoned. Crime and corruption pay handsomely here. Our leaders do not inspire us to become productive and industrious, law-abiding tax payers. The overseas Filipino is largely responsible for any economic growth worth mentioning.

The lesson dear graduates is one you think about every day. How to get out of this country and begin making a decent living. How to get away and begin living in a more equitable and just society. How to leave this mess behind and concretely help your family and country by remitting money.

We can easily become bogged down with dreams of a snap election or a double resignation or a mass conversion among our traditional politicians—everyone’s free to dream. The trouble with this fantasizing is that we depend on our same old tormentors to make things better for all of us.

I, myself am returning to the US in a few days. I will work hard and I will become stronger so I might come back to fight another day. In one of my favorite movies Cinema Paradiso, there is a scene where the young Salvatore leaves his hometown Giancaldo, and whereupon his blind and old mentor Alfredo throws in a final bit of advice: never to return and that holding onto the past will keep him from going forward. I am telling all of you to go and find your destiny but never forget the country you leave behind and all our unfortunate sisters and brothers who never had the chance to live their dreams. Congratulations to all you Grads!

Thursday, March 13, 2008

The GF

I can imagine the one person loving all this, feeling totally like the Godfather (GF). This latest development with witness Leo San Miguel seems almost lifted from the movie when Frank Pentangelli was scheduled to testify before the Senate Committee. Moments before he was about to rat out the entire operation, his older brother, newly arrived from Sicily and not speaking a lick of English enters the spacious chamber.

That was all it took. Frankie Five Angels instantly forgets his testimony and the entire room erupts into chaos. Case dismissed.

The story isn’t over though. Michael “Mike” Corleone leaves the senate building and immediately plans to kill his brother Fredo and Hyman Roth. To which the exasperated consigliere Tom Haden mutters, "C'mon, Michael. You won. Do you feel you have to wipe out everyone?"

Mike’s classic response: "No, Tom. Only my enemies."

Saturday, March 8, 2008

My Diagnosis

Less than a year ago, Jess Paredes, Adrian Sison and myself were going around the country essentially telling everyone that we volunteered for a suicide mission precisely because we needed to have the right to say “we told you so”. There are so many Filipinos who can contribute much to our country but who have their personal reasons why they choose to stay out of the fight. These are the same Filipinos who are now counting upon their religious leaders, officers of the armed forces and ironically, their elected traditional politicians to deliver themselves from the dishonest dispensation of Gloria Arroyo. What can be more na├»ve? It’s certainly more of a stretch than my dream of a Raul Gonzalez conversion (for some reason, looking back on better days, I haven’t lost hope in this).

To those of you who voted for the “opposition”, did you really expect them to disrupt their preferred positions in the political food chain? And to those administration loyalists, were you seriously expecting the likes of Senators Joker and Zubiri to fight for the education and healthcare and ultimately for the lives of the millions of poor children at the expense of their personal friendship with Gloria and Mike?

We are all schmucks, we are all underlings if this had been our collective delusion. And I am not sour-graping, that millions more would have supported us three to give real change a chance because I myself had to rush back to the US after the elections in order to make a living for my children. I realize we all need to protect our own little interests and it is to the desperately hungry and the chronically ill and the truly poor and dispossessed people to rise and right this disastrously unfair, unjust, and abysmally anti-life system that is killing them.

And here is where the gastroenterologist makes his diagnosis: because we do not have sufficient love for these, the very least of our brethren who consistently sell their votes and behave like wild beasts concerned only about their day to day survival. I am doing good, my kids are going to good schools and they are well within the normal curve of the growth charts, my responsibilities are met and I sleep well every night.

We have seen the enemy.

Wednesday, March 5, 2008

Colonoscopy Caveat

Colon cancer is the second-leading cause of cancer death in the United States, after lung cancer, with about 154,000 new cases detected and 52,000 deaths a year. This is tragic because most of these deaths could be avoided if screening colonoscopies were performed more often.

In the US, gastroenterology graduates are woefully in short supply. This is why many enterprising surgeons and general practitioners have discovered the lucrative potential in performing colonoscopies even if many of them were inadequately trained to look for flat lesions that the Japanese doctors had been telling us all along, were dangerously precancerous or outright malignant.

In a study of 1,819 military veterans, it was found that 9.35 percent had flat lesions, and those lesions were five times as likely as polyps to become malignant. Poorly trained physicians know only about stalked or what we refer to as sessile polyps. We can only guess how many of these flat lesions escape detection.

The study underscores the importance of determining the level of training and guided experience of the colonoscopist. In the institution where I trained, our program director would remind us that even a monkey could be trained to guide a tube through the colon. The real skill lay in the recognition of risky lesions.

Tuesday, March 4, 2008

Out with EO 464

If Gloria Arroyo is really serious in searching for the truth, she needs to revoke Executive Order (EO) 464, which prevents government officials from attending congressional inquiries without her personal clearance. Even her close ally Zubiri, who was dubiously elected to the senate last May, a clear beneficiary of the full support of Ben “counter” Abalos stated “With the revocation of EO 464, it will show that government has nothing to hide and that it supports full transparency and accountability”.

But Gloria Arroyo is hiding many things and she must be terrified at the prospect of the lifting of this gag order. Let one of these trapos talk, or allow one of these weaklings a chance to gain redemption and the walls will come crumbling quickly.

This is why the Bishops were not all that bad when they demanded the scrapping of this ridiculous rule. Everyone around here knows if a serious investigation is initiated, Gloria is cooked.