Sunday, April 8, 2012
INTRODUCTION TO AUGUSTO PEREZ SARMIENTO, MD, FACS, FPCS
I have been presented the daunting task of introducing our commencement speaker for this afternoon’s graduation. I am overwhelmed, yet privileged and honored, to say the least. How can one begin to describe a master surgeon, pioneering healthcare entrepreneur, competitive sportsman, loving family man and a consummate practitioner of the art and science of healing?
He graduated from the University of the Philippines in 1948, just as the nation, newly independent, was healing from the wounds of world war. Under the tutelage of the great Januario Estrada Sr., he received his surgical training at the Philippine General Hospital.
In 1954 an opportunity came to train as one of the first Filipino surgical residents at the Memorial Sloan Kettering Cancer Center, the Valhalla of Cancer Surgery in New York City. He stayed for four years, completing his training under the American surgeon widely regarded as the Father of Head and Neck Surgery, Dr. Hayes Martin.
He became a member of the American College of Surgeons, the James Ewing Society, and the American Society of Head and Neck Surgeons, as well as the American Society of Surgical Oncology. He worked for a time as an associate of Dr. Martin, but decided to forgo the glitzy lights and prestige of a Park Avenue Manhattan surgical practice, returning to Manila in 1958.
He taught and practiced general and cancer surgery at the PGH and at the newly inaugurated University of the East Ramon Magsaysay Memorial Medical Center, and practiced privately at the Manila Doctors Hospital with the group of Dr. Ambrosio F. Tangco.
In 1967 he moved his practice along with several overseas trained UP doctors to join the esteemed Agerico B. M. Sison in a diminutive hospital near Highway 54 among talahib and carabao tended flatlands owned by the Ortigas family. It was named the ABM Sison Hospital, in honor of their mentor.
By 1969 our guest speaker, along with the other like-minded young associates of Dr. Sison found the financial situation of their 2 year old hospital in dire straits. In a bold stroke, this intrepid group of physicians, along with visionary financiers from the banking community had the Sison family agree to these young doctors’ assumption of fiscal and management responsibility for the ABM Sison Hospital. These young MDs named their group Professional Services, Inc., and renamed the facility The Medical City General Hospital.
Today The Medical City, which moved to its new Ortigas Avenue location in 2004, is celebrating its 45th year of operation, and is regarded as one of, if not the best, majority physician owned tertiary health care institution in the Philippines, led by the bold, pioneering vision of its leader, our speaker for this afternoon, who serves as Chairman of the Board to this day. In the present environment of businessmen and financial corporation-led hospital takeovers, the Medical City stands out as a medical center that is still majority owned, and run by, its practicing physicians.
My memories of our guest speaker are rich indeed. I first met him as I interviewed for the surgical residency program at the Medical City a quarter of a century ago. My impression of him was akin to that of a moviegoer encountering a matinee movie idol in the flesh: he looked 20 years younger than his 64 years, wearing movie star shades inside the auditorium where interviews were taking place. Did it matter? Not one bit-everyone knew who he was: former President of the Philippine College of Surgeons, Board Examiner of the Philippine Board of Surgery, Chairman of the Department of Surgery at the Lady of Lourdes Hospital, and, at that time, President and Medical Director of the Medical City.
I had made a leap of faith in choosing a private hospital for surgical training, as I had come from a closed world where UP taught you that outside of PGH, surgical training was shoddy and inferior. I had yet to know, as it was slowly revealed to me, that great surgical training meant watching, then assisting, then operating with the best surgeons as they manage the three elements of surgical education: first, imparting current knowledge with the end of correct decision making and good clinical outcomes; second, imparting sound surgical skill by watching the best surgical hands at work, assisting them next, then operating on cases under their watchful eye; and third, imparting excellent surgical attitude by observing, then emulating the best of their mental dispositions especially under pressure, as well as observing, then absorbing the best of their bedside manner.
I knew at the outset I did not want to derive my knowledge, skills and attitude by learning just from senior residents---I wanted to learn my surgery by distilling the best of knowledge, skills and attitudes from the most skilled, loved and successful practicing surgeons of the time.
Our speaker for this afternoon certainly made my training in Medical City worthwhile. I was witness to how a surgical field could be dissected out such that the anatomy was laid out as if it was from an Atlas drawing from Netter’s Anatomy; I was witness to how surgical planes would suddenly open up and be revealed out of nowhere, leading to swift dissection and exposure, about how we observed that blood vessels would literally flee from the dissecting Mayo scissors of our speaker, creating a spectacularly bloodless field.
We felt and appreciated the knowledge he filtered down to us; the nuances of surgical history, of the logic behind surgical decision-making, and how it compelled us as juniors, and especially so as senior residents to bone up on our surgical theory, lest we be left out of his cases. You needed to know the latest current detail of the patient, as that was expected of you, so you mastered pre, intra, and post op surgical management the right and real world way – with paying patients who expected the best care.
Most importantly you learned and emulated the most excellent bedside manner any physician would gift his patients, rich or poor. You would bear witness to how a vacillating patient, wracked with fear, anxiety and doubt about their impending surgery would finally be convinced to submit to our speaker’s knife after he would masterfully present the patient’s current medical situation and how our speaker’s surgical intervention, though invasive and risky, could benefit the patient overall. We saw how patient’s eyes would light up as he entered the patient’s room, and shine all the more brightly as he left it. We saw how the unconvinced would, a few minutes later, be left literally begging to be operated on by this man. Such was, and still is, his magic, his effect on people. This person convinces me all the more that Medicine is the art of healing the mind of the patient, first and foremost. The skill to repair the body complements, but does not supersede, the quality of the physician-patient relationship, the extent to how the physician gives heart to his art.
At 88 years of age, he was, and still is, the inspiration to 3 generations of Filipino surgeons. I am forever grateful to the Almighty to have experienced him, and to De La Salle, for the honor of introducing him.
Ladies and gentlemen, fellow La Sallians, fellow students of the art and science of surgery and medicine, our Guest Speaker, Chairman of the Board of Professional Services, Inc., Dr. Augusto P. Sarmiento.
Saturday, March 10, 2012
An account of the arrival of the second generation of my German ancestors in Jolo, Sulu, 1880
“Unser Leben auf Sulu – Selbsterlebtes von Frau G. Scharlau”
translated from the original German by Peter Schidlowsky (03. 2012)
Sulu is the largest island in the Sulu group of islands in the south of the Philippines. This is where life had once taken me, and although there were difficult times, still they are a treasured, pleasant memory to me, a lifelong nourishment.
My brother, a sea captain, had earlier come here with his ship and started a plantation with coffee and cacao. The land had been a gift from the Sultan of Sulu who was very fond of him. Now, he had his family come to join him from their home in Holstein and, at the plea from my sister-in-law, I went along.
After a stormy passage on a steamship from Hamburg, during which we experienced all the horrors of seasickness, we anchored in Singapore. We stayed there a week, until the coastal steamer was ready to take us to our new homeland. After a 14-day journey, during which we called at several ports on North Borneo, we finally put into the port of Sulu. And finally the new homeland was before us and we looked longingly at the scene, sharp and clear despite the lateness of the evening. Before us, on a bay, lay the town of Jolo, with its white-painted houses and gleaming tin roofs, the mountains in the background, around us the calm sea quietly lapping at the hull of the ship, and above us the most gloriously starlit sky, as it can only be in the tropics—each star shone extra brightly for our arrival and even the man in the moon smiled a friendly welcome. Who would blame us for allowing the old homeland to fade into the background, given the story-book aspect of the new.
All too soon we would be called back to reality. The signal pipe announcing the arrival of the ship was heard on land and soon the harbour-master came alongside in his boat. The ship’s ladder was let down and he came on board to collect the required papers and to inquire as to our health. All went smoothly, nothing stood in the way of the landing of the passengers and the cargo the following morning. The harbour-master was already on the way back to his boat when I asked him a small question: did he know if Captain Schück was in town or at his plantation? But alas, he was a Spaniard (at that time the Spanish ruled the island) and understood only his own language, which was as Greek to me as my address in French was to him. But he had understood the name and stammered that Captain Schück had left early this morning on a German warship for Maimbun on the other side of the island, where the Sultan of Sulu resided. We were completely dumbfounded, but soon the riddle would be solved. Again we heard paddles in the water, a second boat came alongside and a voice asked in German, if Mrs Schück’s family was on board. We were electrified and delighted to hear a familiar tongue, and a jubilant “Yes, we’re here” resounded from us all. It was a German who had been living on the island but now wished to return home. He bid us welcome and sais that my brother had indeed gone to Maimbun on the German warship Iltis I, to see the Sultan, partly as pilot but mostly as interpreter between the Sultan and the ship’s lieutenant-commander. It would probably take 2-3 days until the ship returned but he’d try to find a man to ride across the mountains to inform my brother; perhaps he would then return sooner. Admittedly, it wouldn’t be easy to find a messenger, as there was great unrest in the land and yesterday there had been a significant battle between the Sulu people and the Spanish. The Sulus had wanted to storm the town but had been driven back—150 Sulu men and a number of their women had perished in the skirmish. Well, that was nerve-racking news, to say the least. But he assured us that we needn’t fear—we Germans were quite safe. For the moment we should stay on board until news arrived. Tomorrow he’d come again, to chat and while away the time; for now it was goodnight. It was time to get some rest and we went to our berths with very mixed feelings. We let ourselves be lulled to sleep by the gentle motion of the ship until we were wakened in the early morning by gunshots and yells. A few more bold Sulus had climbed over the town walls, had attacked the sentries and on both sides there were dead and wounded.
Early morning found us again on deck and the bright illumination of the sun was in sharp contrast to the scene the previous night. We could now distinguish everything clearly and saw that all the houses were on stilts. We found out through our countryman that the inhabitants were Spanish military personnel, also “deportados”, i.e. criminals brought from the Philippines, who had to earn their keep under military supervision, but most of the people were the Chinese, living from trade. In the harbour there were always 1 or 2 Spanish warships. A mail-ship came down from Manila every 14 days; also 2 or 3 trading ships during the month, from Singapore. A few small British warships put into port as well, but above all we enjoyed the mighty German protection, as each year His Majesty, Kaiser Wilhelm I, sent one of our German warships to enquire as to the welfare and problems of his distant subjects. Where for us those were red-letter days, for the Sulu people it was hugely impressive. During my stay there, we were visited by SMS Iltis I, Wolf, Stosch, Leipzig and Nautilus. So, despite being in a distant, foreign land, we were not completely forgotten and cut off from everything, as we had feared, neither were we in want of work.
We remained on board for another 2 days, watching the traffic on land and with the boats, saw also how the fallen Sulu warriors were carried out to the open water, to be buried at sea: a cool grave, counted on by each combatant, because for them it is an honour to die in battle against the Spaniards—according to their beliefs, it honours Tuan Allah greatly, and before they leave for the fight, they have their priests bless them and often get their jacket embroidered with verses from the Koran. Finally, on this 2nd day of our involuntary quarantine, two dark points appeared on the horizon, gradually developing into masts, and after a number of hours SMS Iltis I dropped anchor. Obviously the messenger had crossed the mountain unscathed and the business could be concluded quickly, thus ensuring a speedy return. Soon, we were invited on board the Iltis and we spent a very happy day there. But, already before sundown we had to part and were swiftly rowed ashore.
We went to my brother’s house built on stilts and directly on the water. It was almost empty and we camped there for the night. We had hardly been in the house when the Iltis’ officers made their return visit, bringing baskets full of “forage”—neither before or since did the house ring so merrily with laughter as on that evening. The next morning my brother announced his family’s arrival to the governor of Sulu. At the same time, he asked him for a horse—so he could ride out to his plantation to fetch mounts and escorts for them—as well as permission to enter the town. However, he received permission only on condition that he take over responsibility for the safety of the people and that they were to leave their weapons at the watchtower, a quarter hour outside the town. Since the raid, entry points to the town were closed at all times; the natives were never allowed in with their weapons, kris, and rifles, or without special permission. The requested promise was given, my brother rode off, so as to be back by 4 p.m., when the heat was no longer so great. We used the day to organize our now-landed baggage, with a view to facilitating delivery, as there were no buffalo carts or moving wagons here. We had to fetch the items often and soon, as each day the monsoons (mid-April to October) could set in—and here, one can sure learn what rain can be! One can imagine how excited we were, feverishly so, about all the new things yet to come; we could hardly wait.
Finally, my brother returned with mounts and escorts: 7 horses, each with 2 escorts. The Sulu people, quite handsome, yellowish-brown faces with dark eyes, very short-cropped hair, a turban-like cloth wrapped around the head, clad in a tight jacket and pants, the latter held up around the hips by a 2-3 meter long sash (candit) into which the kris is inserted. Lips dyed red, teeth filed down, and the inside of their mouths black as Hades. At first, one is startled by such a sight, but then one gets used to it. Now we mounted the horses, each led by one man and flanked on each side by another man for protection. The younger children each rode together with a rider. At the rear, my brother walked with his wife (she had broken her arm during their trip and was afraid to ride) and two buffalo carts brought some of our belongings. We passed the governor’s house, a Spaniard, who was expecting us and accompanied us to the town gate which was shut again behind us, and we were left to “our Lord and good luck”. A surprise awaited us: when we arrived at the watchtower, there must have been around 80 men from the plantation and vicinity who had come, on their own initiative, to greet us. The oldest man of the island, in his sixties, led them—he wanted to be the first to meet the wife and family of the German who lived without fear amongst them. The people now got all their weapons back and formed a circle around us. Thus protected and led by the natives, we made our way in. We had to cross woodlands, a presently-dry riverbed, over little hills, and finally the house, that was to be our home, appeared before us in a large meadow. And, just as the men had come to meet us at the tower, so now the women and children had gathered in front of the house to greet us. Finally we could dismount and enter the house, whose much-touted beauty we were so curious to see.
But our faces showed increasing disappointment. It was a farmhouse made of boards, coconut trunks and bamboo. Coconut palm leaves covered the roof. There were no windows, i.e. there were no glass panes, only large window openings— in the evening, a screen, made of palm branches held in a frame, was simply placed in front. A veranda ran all around the house, protected by the roof from wind, sun and rain. The house stood on posts, so high that underneath was the stable for horses, buffalo and a few scrawny cows. The 5 rooms were large, but lacked all comfort and order—it was evident that only men, under leadership of natives, lived here. Sideways on the veranda sat the kitchen, usually the pride of every housewife, but here was very primitive. One learned to limit one’s wishes and dreams to the most modest level. It was good that we didn’t have much time to think; one had immediately in the first hour to get to work, unpack, put away, make room and organize as much as possible and then satisfy all the hungry faces—there were 12 persons. Yet we took enough time to bathe in the river which flowed at the foot of the hill on which stood the house; it was a refreshment that we enjoyed daily, early in the morning and in the evening.
Now began a busy time for us and we couldn’t complain about a lack of variety in our tasks. First, the house had to be made livable, which we achieved gradually through our combined efforts and the things we had brought from our former home. More difficult was communication with the native people-- our ears and brains could not so quickly assimilate the new (Sulu) language what with the multitude of new impressions coming at us. In the beginning we used mostly sign language. It was time to adapt to a completely different way of life, to learn to make use of the local products, to dispense with a number of old habits, and to do without many things. Potatoes, like the ones we knew at home, were non-existent; there were only local fruits and the tapioca root which tastes like the German potato and can be used for many things. We were told that, if we wanted fresh bread, we’d have to bake it ourselves—there was flour and an oven (a very nice one, too). Oh boy! We city-dwellers, who were used to getting everything from the baker, would have to do it ourselves. But what could we do—we had to try, and after a few failed attempts, we succeeded. One of our plantation workers, a Spanish “deportado”, showed us how—he turned out to be a cook, offered his services as such and was eventually taken on. For a while though, I still wanted to do everything myself, but eventually this idea took care of itself, the tropical heat and glowing fire being too much for a European woman.
At first, it was difficult to get fresh meat on a regular basis. The messenger had to leave for the town soon after 6 in the morning, so as to return before the heat, otherwise the meat arrived already spoiled. If necessary, actually often, chickens were slaughtered—unlike back home, in Sulu they were not a delicacy. Eggs were a daily staple. Once we had a well-stocked chicken coop, there were fewer supply problems, but in the beginning there were many headaches. And butter! A precious item, when it was available. How often was I at a complete loss as to what to use for cooking, then I was told “here is coconut oil, that’s what you use for cooking”. I was dismayed over this unreasonable idea, but what could I do, I had to adopt it. One of the Sulu women taught me how to make use of it in a tasty way and then it went quite well. One of our people, a passionate hunter, brought us wild pig; he also shot parrots, which were prepared like doves. We got fish in town, also rice. This main food staple was always available in big bags, as the workers also got some. Fruit was wonderful and abundant—coming partly from our own land, but also brought from the mountains. Vegetables were very inexpensive and always delicious. With few exceptions, the fruit is more juicy than meaty: the meatiest fruits are banana and pineapple, the banana available year-round. Gradually I learned to use the fruit as a compote and, when I served the first filled pancake, there was great joy. In the beginning we also had to do without fresh milk and get used to canned milk. Then we found several buffalo cows, which were fed a special diet of corn and fresh grass. Our cook knew how to milk them and so we got 2-3 liters of fresh milk, richer than from European cows, with a slightly salty flavour and thus more digestible. In this way we gradually became accustomed to everything and a great step was made once we were familiar with the food and other comforts.To be sure, it had cost a fair number of deep, sorrowful sighs and secret tears.
Now the rainy season had begun, which lasts from April to October, admittedly not continuously, but daily, hours at a time, often also non-stop for days on end. Oh yes, the rain pours from the sky, and how!—here (in Europe) we have no idea. We often had to shut doors and windows and have the lights on all day. Fortunately, the house was built on stilts and stood on a mountain, so that the water drained more easily; otherwise, we would have been in danger. Our normally so placid river became a raging torrent, bringing uprooted trees and bushes down from the mountains, which then created dams over which the waters came crashing. Of course, the sun shone again and dried the soil faster than here (in Europe), so that we could once more get out in the fresh air.
During the monsoons, work on the plantation was reduced. The people’s rice fields were planted, weeding was done during the nice days or hours, a field was freshly-plowed, or the fields were planted with coffee, cacao, banana, pineapple and manila hemp. That was the produce of the plantation and, when the the coffee-bushes stood covered in blossoms, it looked enchantingly beautiful. Later, when the umbellate fruits clustered round the branches, the berries smelling like our cherries: two flat beans, close together, or just one round one, surrounded by juicy flesh. The coffee tasted doubly good when it was oneself in charge of its production, right into the aromatic, strong brew in the cup—it was with great joy and enthusiasm that I devoted myself to the task.
The island also offered many natural attractions: mountains, forests, valleys, rivers and the sea. A ride into the interior or to the ocean was a pleasure that unfortunately became infrequent. The Sulu people (the Moros) remained faithful to us: they were generally good-natured and except for the Spanish, greatly admired all Europeans, especially Germans. The Moros work hard (in their way), lead simple lives as they have few needs, live in the huts they build themselves, using coconut trunks and bamboo. Should the dwelling disintegrate, they simply build another. There’s enough room for that, as the population had shrunk due to disease, war and hunger; also, there are no immigrants. Only in the two port towns were there Chinese settlers, who worked in the business of trade: Jolo on one side of the island, and Maimbun, where the Sultan lived.
The entire population is Muslim; they strictly follow their religious laws, going every Friday evening to the Langal (church/mosque), where a sub-priest/imam, who also works on the plantation, read from the Koran. True to their faith, many have several wives, with whom they live more or less happily, which likely depends greatly on how the women get along with each other. Jealousy is not an option. A sad marriage law exists there: if the husband is tired of one of his wiwes, or if she bears him no children, he is permitted to return her to her family, but as soon as he calls her back, she must join him again. He can send her away three times, and each time she must come; only on the fourth time can she refuse him and no one can force her. After 100 days, she is free to marry again. There are no old maids there. Sadder still, I found, was the slavery that existed there, which tore apart whole families. This is mostly a result of a unique, profiteering law there. For example, should a man not have enough rice to plant his field and he borrows an additional 1 Gantan (2 litres), he will then owe 1 Kavann (50 litres) at harvest. If the harvest was poor, a buffalo (if he owns one) is taken from him, or his wife, his child or he himself will be taken as a slave. The lender often pays his own debt with these slaves and so people end up going from one hand to another; most often, parents and children no longer know each other once they can be reunited. No outsider would be surprised then, that these arrangements are not willingly entered into and often result in persistent fights, even secret abductions.
Shortly before our arrival, the Sultan of Sulu died and his oldest son, a man of 18, took his place. Despite the small size of the country—the whole island was slightly more than 5 miles across—there were people in one settlement who would not recognize the new ruler. So he went there, accompanied by his advisors and many of his slaves, and by force of arms was able to quickly assert his rule. We had no inkling of this fight, but suddenly we were told that the Sultan would visit us. In no time at all, the room was prepared for his reception. We quickly changed clothes and, with pounding hearts and great anticipation, we looked forward to his arrival. We had assumed an impressive procession, but dear me, we were bitterly disappointed. Coming toward our house was a disorderly group, armed with kris, lance and rifle, not exactly a pretty sight, more akin to a wild medieval raping party. They were soaked to the skin—it had rained all that day. We looked for the Sultan in vain; then, from the middle of the crowd, which had stepped to the side at the stairs, a youthful figure emerged, not much different in dress than his countrymen. My brother greeted him as Sultan and led him into the room. All our beautiful illusions of a magnificent state, splendid horses, and magnificent retinue were destroyed: no Sultan could have looked more prosaic. He apologized for his appearance, blaming the recent battle, but for us the disappointment was bitter. To be sure, during later visits, I had seen him in full splendour and rich surroundings, but I could not forget my first impression. He ruled only three years, then died very suddenly. His younger brother, under tutelage of his mother, took his place.
As beautiful and different as it was from what we had been used to before, life there was marred by sickness, even death. All of us, more or less often or hard, had to fight the fevers brought on by the climate. In the second year of our stay, cholera ravaged the island. I lived three years there, another two in Singapore, then it was time to pull up anchor for the journey home, time to remember what I had seen and experienced, and to exclaim in my mind: “O world, how very beautiful you are!”.
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Sunday, July 4, 2010
Beyond the Wang Wang: Fixing Road, Traffic and Pedestrian Discipline
Has Ancillary Effects
Mr President,
When one visited Gordon's Subic in the mid 90's, it was like entering
a different world far removed from the chaos of road discipline found
in urban and provincial Philippines: We would actually stop at
intersections, observe speed limits, walk in the proper lanes. We knew
we would be flagged and caught for noncompliance. It came to a point
where even when there were no Subic cops physically around, we
followed these internal road rules anyway. Why is our road and
pedestrian behavior in Subic and in other countries exemplary, only to
horribly deteriorate when we step out of these places? It is simply
discipline and enforcement, stuff that the "common tao" should see,
observe, feel, internalize, comply.
When we see law enforcers corrupting themselves with "tong" and
"lagay" in our very streets, we permit road chaos. Jail these errants.
Replace them with young, idealistic incorruptibles.
Mendicants and hawkers on public roads? They are jaywalkers and pose a
road hazard to us and impose a health hazard on themselves. Apprehend
them and their "business managers" who allow them on public roads
which are for motorists and pedestrians, not for them.
When we see motorists making "lagay" and giving "tong," jail them.
Jaywalkers? Apprehend them. Apo Ferdie in the 70s made them trim grass
as their fine for all to see. That was a good thing, right? It should
be made shameful to jaywalk.
Smokebelching public transport? Give our Vice President who rode to
his June 30 inauguration on an e-jeepney something worthwhile to do.
Have him electrify or solar power ALL urban and provincial buses
jeepneys and tricycles. They have solar powered tuktuks in Thailand
already, don't they?
Buses, jeepneys, tricycles that don't avail of their stops and keep to
their designated lanes? Suspend their licenses. Reinstate them when
they show evidence of compliance in our streets.
Public conveyance stops are to be situated in places AWAY from thruway
traffic flow. Eliminate bus, jeepney and tricycle stops that impede
thruway traffic flow. Forever. Pedestrians walking a bit longer to
their destination will be good for cardiovascular health anyway.
Mallowners and building permit issuers should be prosecuted for
building their "traffic magnets" in proximity to major roads.
Remove vendors and physical obstructions from public sidewalks and
conveyance stops. Please.
When the common tao sees and feels the effectivity of enforcement of
road, traffic and pedestrian rules on our very streets, they will
learn to comply with their other civic duties and responsibilities as
paying their taxes and not breaking the law because they will realize
that the State will not let them get away with it.
We need to feel your changes first on our streets, Mr President,
beyond the wang wang. The State must impose order to the War in Our
Streets. This war is ongoing, the enemy is the lack of discipline and
law enforcement, and the State must win this war QUICKLY to make our
streets the FIRST visible, palpable shining example to the world of
your resolve.
ENFORCE DISCIPLINE ON OUR ROADS. IT WILL HAVE EFFECTS FAR BEYOND THEM.
Sunday, June 6, 2010
Improving Universal Health Care and Heath Security Has Ancillary Effects
Mr President-Elect,
When he inherited his young island nation from the Malaysian
Federation, and faced with a raging, gargantuan communist insurgency,
Lee Kuan Yew of Singapore told his 200 "best of the brightest"
associates in 1965 that "whatever the Reds offer, WE HAVE TO OFFER
SOMETHING BETTER."
We can learn from Singapore by simply starting with health care.
Doctors are sorely needed in 90% of the Philippines. Medical students
after passing Medical Boards are to be issued certificates of medical
licensure AFTER they have completed 2 years of national medical
service in the provinces. As with Singapore's public servants, doctors
in provincial service will have to be paid INSANELY WELL. If this
works well with doctors, pay the rest of our government public
servants similarly. The best and the brightest of Singapore were
recruited to serve in government, and it helps that they were paid
better than the private sector. With fiscal discipline (clamping down
on corruption) and stern justice (Internal Security Act), they made
Singapore First World in 20 years. Try it here in the Philippines.
To improve access of Filipinos to healthcare facilities especially in
acute situations, a nationwide interisland and road/port/bridge
infrastructure has to be started. Employmemt in this giant nationwide
infrastructure project will generate jobs for millions of Filipino poor.
A national health identification system ID card should be issued to
all citizens containing their past and current medical status. This
will also improve domestic security and enhance revenue collection. No
compromise.
In Cuba there is a hospital for every 5 barrios. This can be
replicated in the Philippines. An economically viable model should be
a 100 bed hospital. Building 90,000 such hospitals (1 hospital for
every 1000 Filipinos) should cover the whole population. Hospital
building generates businesses and jobs.
Doctors need to be secure to practice in the remote barrios.
Increasing the military and police budget to enhace sustained security
will encourage doctors and rural people to stay in their areas. Our
fathers brought down Taruc from the Huk boondocs in the 1950's using
the successful Magsaysay-Landsdale model of dealing with insurgency, a
model we should revisit.
There must be a research hospital in each province and region to
specifically identify and address solutions to public health problems
unique to each province/region and to create practical technologies
and health care models unique and appropriate to each area.
Taxation will need to be improved to fund the Philippine Health budget
from its current 2% share to 15% of the national budget.
Enforcement of taxation on Filipinos will require a revamped justice
and law enforcement system to ensure compliance.
Funding will be assisted by encouraging the "oligarchs" (the term
Ferdinand Marcos and Ninoy Aquino used to describe the Philippines'
super rich) to moving their overseas funds back to the country's
local financial institutions, like the Indonesians.
PhilHealth, currently underfunded, should be expanded to include FULL
coverage for every service, including big ticket procedures like organ
transplantation, coronary bypass, and chemotherapy (kaawawa-awa talaga
ang Pilipino). Current shortfall in Philhealth budget is due to the
overwhelming failure of remittances by companies of their employees'
Philhealth contribution. If the justice system and law enforcement
will be consequently revamped and improved this can happen. Revenue
collection has to be improved and this will not happen with poor law
enforcement and a slow justice system.
Telecommunications have to be upgraded to allow Filipino MDs here and
abroad to help local experts in remote areas via telemedicine
encounters and remote (robotic) surgical procedures. This must be made
ubiquitous as we can have the best expertise without having our
overseas and local urban experts physically present.
Public sanitation infrastructure development to the barangay level
quells disease and generates employment.
Vying to beat India, Thailand and Singapore in Medical Tourism
promotes jobs and generates income. The Filipino, because of his being
"mapuso" (heartfelt, genuine and caring concern for another), is
undisputably the world's best service provider. We have to complement
this trait with world standard technical proficiency, and we will be
unbeatable.
Pollution control and going green promotes health and employment.
Improved law enforcement and a justice system will aid this.
Local pharmaceutical manufacturing (our drug prices are one of the
world's most expensive) promotes jobs and research.
Initiating Sports Development Infrastructure generates jobs from
barangay to national level while promoting health. By focusing on
certain sports and being competitive in the international sports
arena, these endeavors will serve as an example to our youth to aspire
for sports excellence and sustain a healthy lifestyle. It is also a
natiomally unifying factor as you can observe from the Manny Pacquiao
experience.
To the masa, hunger is alleviated first before he thinks about his
health. Corporate agri and aqua and animal culture steeped in
mechanization and technology are anti hunger and promote food security
and productive land redistribution.
Distill Ghandi, Ho Cho Minh and Mandela and formulate a unifying
national vision. Distill Lee Kuan Yew and be tough and incorruptible
and LOOK, not WAIT for the best and the brightest to help you. Distill
Fidel Castro and emulate a relevant health care plan that will be the
world's envy and the Philippines' pride.
More open letters to follow, Mr President.
Monday, May 31, 2010
01 June 2010
My family wishes to express our appreciation and gratitude to all
those relatives, friends and colleagues who came by to visit our
mother at her wake, sent over flowers, mass cards, emails, Facebook,
Twitter and text messages, phone calls, not to mention your valuable
prayers. We hope that you continue praying for our mom beyond today,
as these are indispensable to assure us of her smooth transition to her
place with all the other saints in Heaven. Though her body is
physically with us her soul is now in that particular place where she
no longer can pray for herself, so it is up to us to
continue these petitions and supplications to assure her entrance into
the arms of our Lord, His Mother and all the other saints at the
soonest possible time.
How can one even begin to describe the incredible 95 years of one
Manna Schuck Montemayor? Born at the outbreak of World War 1 of
industrious German immigrants and fierce Tausug-Samal nobility in the
paradise of islands that was and still is Tawi-Tawi, she was a product
of the American initiated public school system and Pilar College in
Zamboanga. Returning to Jolo, Sulu to teach Math and English at public
school, she met a persistent young clerk of court, a newly UP
graduated lawyer from Alaminos, Pangasinan. Though she had her fair
share of suitors in Jolo, Mamerto Ruiz Montemayor eventually won the
first dance with the beautiful Manna Schuck at the weekly Saturday ball
and a bit later, the heart of this feisty German mestiza, marrying her
73 years ago. Being Moslem,
she converted to Christianity much to the consternation of her Tausug-
Samal mother. They were together for 37 years through war and peace.
Her courage and industriousness first manifested itself when the
Philippines went to war with Japan, as she relocated to her husband's
hometown of Alaminos, Pangasinan still pregnant with her 3rd child
Marilyn and with her 4 year old son Michael and 2 year old daughter
Minnie in tow. She sold gasoline and made dresses to keep herself and
her 3 children alive with nary a clue whether her young husband
Captain Montemayor was still alive or dead fighting the Japanese along
the Abucay Line in Bataan with the 41st Division. After almost 6 months
of not seeing him she finally collected him in
the Capas concentration camp in the summer of '42 bald, emaciated,
lice ridden but alive, and they were a family again.
After Liberation Mamerto Jr came along, the first of three more baby
boomer Montemayor children: Monina 12 years later, then myself. She
made her home at Agno Street, Quezon City, designing dresses and gowns
mostly to friends, augmenting the income of her
husband, by then a military lawyer and trusted associate of Ramon
Magsaysay. In the 50s and early sixties she saw her first three children
graduating from college and obtain further schooling abroad, marrying
and settling both here and in the United States, happy with their
successful professional and family lives.
With her husband retiring from the military and joining Atlantic Gulf
and Pacific, she moved us to the house in Magallanes Village she herself mostly
designed 45 years ago, still sewing dresses, and raising her three
remaining children. Mert, Mona and I saw how she struggled when Papa
passed away unexpectedly 36 years ago with Mert still searching for his
professional roots and Mona and myself still in high school. She
invested in rental apartments and real estate from what she earned
from dressmaking, rented rooms in our Magallanes home, and maintained
a tight budget, eventually completing the mortgage of the Magallanes
house. Her younger children Mert, Mona and I never felt want and
deprivation as she made sure we were schooled well and led a quality
of life unaffected by Papa Dear's demise.
She was there for us in our problems and triumphs. She was there,
unquestioning and unfailing when we needed her. She was there as we
broke out and went our own ways in work and family life, remaining a
beacon in our troubled seas, worrying about our health, our loves, our
work. Through it all she remained beautiful and elegant, active with
the AFP Retired Officers Wives Association and Catholic Women's
League. Her time with her friends were spent on weekly luncheons and
mahjjong sessions which were socially sacred events.
As she aged she saw Mert and I married and Mona professionally
accomplished, complaining constantly about her failing eyesight,
missing out on her favorite Mills and Boon novelettes, gradually
withdrawing from her social circle as she did not want to be viewed by
her amigas as becoming eyesight deprived and socially irrelevant. She
was incessant in seeking a solution for her failing eyesight for which
there was no known cure. She chose not to engage in her usual social
activities. She still managed to be there to go to the US to stand
witness to her granddaughter Maia's wedding at the ripe old age of 83.
As her children themselves started to grey and the grandchildren and
great grandchildren came along she would say that she had nothing more
to live for as she had done her job as a mother. We would always
counter her death wishes by claiming, rather correctly, that she was
German built and was healthier than any one of her children, failing
eyesight and memory notwithstanding. She chose to pass on 72 hours
after her 95th birthday with her last wish having Mona provide her
with a son in law ASAP.
Then as now, Manna Schuck Montemayor defined love: tough and tender,
caring without expectation of compensation, a love ever forgiving when
we her children disappointed her and caused her extreme heartache she
so rightly did not deserve as she was as human as all of us. We forever will
remember her as forthright, God fearing and an ardent lover of our
Blessed Mother, as she was never without a rosary in hand. We pray
that our Blessed Mother will accept Mama Dear in her loving embrace
and eventually take her to that big mahjjong parlor up in the sky
where Papa Dear, Minnie, Anna Felici, Grandpa Billy, Ina, Uncle Pandy,
Tanti Caroline await expectantly. Her name Manna comes from the
Biblical word for “bread from Heaven”. Rightly so, she was our Manna,
our sustenance, our sign from Heaven that God indeed cares for us all.
We promise to honor you and your life
by being the best person we can be, full of love, unconditional,
unfailing. How can we possibly forget you, Mama Dear? You simply live
on in each of us.
Again, we thank everyone in helping us celebrate our
mother's wonderful, wonderful life.
Thursday, April 22, 2010
Commencement Address to the Class of 2010 De La Salle College of Medicine
Br. Gus L. Boquer – President of the De La Salle Health Sciences Institute-Hermano (San) Miguel Febres Cordero Foundation, Members of the Board of Trustees, Vice Chancellor Dr. Ramona Luisa P. Santos – (Academics), Vice Chancellor Dr. Mel Victor G. Frias (Research), Vice Chancellor Dr. Charles Y. Yu (Mission and Linkages), Vice Chancellor Dr. Alvin D. Crudo (Shared Services), Vice Chancellor Sr. Francesca San Diego (Hospital Operations), Associate Dean of the College of Medicine Dr. Josephine Carnate, Mr. Reynaldo G. Cruz our Registrar, Executive Director of the De La Salle Alumni Association Mr. Benjie Uichico, Esteemed Members of the Faculty of the College of Medicine and Non Medical Staff, Distinguished Graduates of the Class of 2010, alumni and alumnae, parents, friends.
Twenty-one years and many many pounds ago when I was a 2nd year surgical resident I was asked to deliver the Main Remarks as Guest Speaker of the High School Honors Assembly of La Salle Greenhills, my elementary and high school alma mater. There I met my old grade school principal, the late great Brother Rafael Donato, who was I believe President of Greenhills at the time. Upon mentioning that I was a surgical resident he informed me Emilio Aguinaldo College of Medicine had recently become part of the La Salle system, and that I should visit Dasmarinas, Cavite sometime. Well, two decades later, here I am Brother Rafe, not only visiting, but addressing De La Salle’s College of Medicine Graduating Class of 2010. I could not ask for a greater privilege.
How did I deserve to face you, the Class of 2010 as commencement speaker? I cannot fathom any reason except that I, too, swore to the Hippocratic Oath just as you will a few minutes from now. What wisdom can someone surgically trained in private hospitals, engaged in purely private practice, teaching formerly and currently at private medical schools and at the cusp of middle age possibly impart to medical students graduated by their school a few minutes ago? Nothing profound, I assure you; just simple, practical tips from a not-yet-so-senior medical practitioner.
First, you cannot thank your parents enough for what you are and what you have accomplished today. When I was in fellowship training long ago and far away, aside from surgical residents I would handle medical school students as part of their clinical training. These bright, incisive young people from Ivy League pre medicine programs would castigate me no end when they learned I was an overseas medical school graduate. They would first ask me how I paid for my medical school education. When I would tell them my parents paid for medical school they would tell me: “you are too fortunate, Doctor Montemayor. We had to take out a bank loan just to pay for medical school.” I did not know how to react; whether to feel guilty Filipino medical students such as I never had it so good - and how different the resulting motivation to study hard, to learn as much, to make the most of one’s medical schooling would be between someone who had to borrow money versus someone given money to become a doctor. How fortunate we all are indeed. The perception is true. Most of us had our medical education served to us on a silver platter. These last four years, dear graduates, how did we manifest our gratitude to our parents? How did we translate our thanks for this tremendous sacrifice they made into something palpable or valuable or worthwhile? How did we for our part honor their sacrifice and effort to allow you to sit where you are today in your toga and masons cap? Never forget what they had to do by being the best you can be. As a parent myself it would not be as much expected as appreciated.
Secondly, help La Salle--the school that educated you. The La Salle physician is both a teacher and healer, as the DNA of a La Salle School is education for the least fortunate. St. John Baptist De La Salle made it his commitment to teach the poorest of the poor, without compensation. He taught others to become teachers in the same way, without compensation. As a La Salle medical school graduate do not forget not only to heal, but to educate as well. Remember St. La Salle’s commitment to the poor. Teach your patients both rich and poor as you doctor to them. Teach them not only what to do when they are sick, but more importantly teach them how to be well. Promote concepts of wellness, for that is the springboard of preventive care.
Your school and its teaching hospital is expanding to enhance the ability to connect with our intended market --- the most deprived and unfortunate of Filipinos who cannot or barely can pay for their medical care. When you are financially fortunate enough, do not forget La Salle. The physical environment you immersed yourself in the last 4 years is a lot different from whence you started your medical schooling; it has become, by leaps and bounds, a better environment for you to learn: new buildings, new library, new facilities. For the institution’s expansion to proceed we need financial help and we look to you our new alumni to help La Salle and its teaching hospital serve all the more patients.
Thirdly, know right from wrong, the truth from the lie. As a Filipino citizen we see our environment clouded all the more not in black and white but in a gray haze of untruths and distortions of reality. You must stand your ground, and ferret out the truth. As recent history shows, the La Salle community has emerged as one of the very few beacons of truth, calling corruption by its very name, protecting the truth tellers and whistle blowers, demonstrating to Filipinos who still care that political stability should not rest on a bedrock of lies and untruths.
As for the medical field, further the truth by considering research for those of you inclined to it. Research confirms and reveals truths. Your school is committed to research. Research is sorely lacking in Philippine Medicine. Enhance Philippine medical research; organize it, lead it, fund it. Not all western medicines work well with Filipino patients, not all western algorithms can be applied here in the local setting. Our economy cannot support too many currently emerging but expensive diagnostic and therapeutic technologies. Local research injects more relevance in patient care, resulting in better patient outcomes for Filipinos at more reasonable cost.
Fourth, fulfill the needs of your country. When I graduated from medical school 24 years ago, we had just deposed an overstaying president. We as 4th year medical students were part of medical teams stationed at Mendiola Bridge that fateful February night. We cut our hands feet and legs pushing away the barbed wire as we inched closer to Malacanang upon news of the flight of its long time occupants, first as a hesitant walk, later graduating into a giddy run as others scaled the once forbidden gates. I will never forget the feeling of being part of history. People were not only happy, they were euphoric. As I contemplate the past, examine our tumultuous present and pray for our nebulous future as national elections near I sense that great change is afoot; we must stop betraying each other, work together and echo our desires into productive action.
How do you as young physicians help your country? Being helpful certainly is embedded in doctoring anyway, you so rightly may claim. What do we need to do as physicians aside from doctoring? Will you be less patriotic if you treat foreign patients if you decide to relocate overseas, or if you decide to confine your practice, as I, to pay patients in an urban setting, knowing well enough that large numbers of our countrymen reside in rural areas and barely have or do not have access to a physician? The short answer to this difficult question is that there is none. There are thousands of permutations to helping our underserved countrymen. Choose a path that works for you. If living and working abroad would become your chosen path realize that because of technology the world has shrunk to the size of a town hall, a barangay, and the physical boundaries of the Philippines have forever dissolved in the face of email, social networking, SMS and cellular phones. The Philippines because of its citizens and new technology has become a nation without borders—a worldwide nation. We will technically never leave our country anymore. The sooner we realize this and get our act together as a worldwide country, the better things will become.
Fifth, you will not be happy in work you do not love. There is a world of difference between aptitude and passion, about knowing what you are capable of doing from what you enjoy doing. Some of you are already decided what they want to do, others not so. Discern what your passion is early on, and follow it. What particular aspect of medicine are you most passionate about? You are currently at a crossroad – many paths lie ahead but you have to choose one. Unfortunately as you advance in your medical career one will definitely encounter more crossroads, each become busier and busier, making one’s decisions harder and harder to make. Choose something that ignites a fire within you, a fire that burns brighter with each day.
Sixth, as you further your training and start your practice, the tried and tested qualities of availability, affability, affordability and being amiable will always be desirable. However, know also how to properly sell yourself. Everyone is a salesman. Somebody always sells something. It may be a physical product, a technology, a service, a skill, an image, a perception, attitudes and values. Doctors are not exempt from selling their skill. I do not mean this in an unethical way. Connecting to your intended audience lies not merely in the non-medical realm but is totally relevant in your future medical practice. Learn the concept of differentiation. Ask yourself: what will make a patient choose you as his physician? What will differentiate you from the other doctor with the same skill set?
Seventh, be fearless. Success they say is a series of mistakes. Mistakes are for the learning. Do not be afraid to err, as long as you learn from them. There will be mistakes you will make, mind you, in the course of your medical training and practice that will result in the unintentional injury and death of those under our care. These situations will happen and will be difficult to bear, but that is the stark reality. To honor these patients we must learn to be the better and wiser for the errors we unintentionally make. The climate in Philippine medical practice is not as litigation happy (yet) as that of other countries. It may very well become so, but as long as you appraise patients of all the possible complications of tests and treatments, when you allow patients to take part in their medical care and communication lines are always open, you will be spared the bane of litigation. Take good care of your patients, and your patients will take good care of you. Fear, though a great motivator should not make us cower, but soar to greater heights. Observe Manny Pacquiao when he climbs the ring prior to a fight. Observe his face and countenance…absolutely fearless. Stay clear up here--supratentorially; never allow people or situations to get into your head and affect your actions and thinking.
Eighth, learn to handle politics, especially in the medical workplace. The sooner you realize politics is everywhere and in everything you do even as MDs, the better you will be able to handle what I term “people situations.” As you further your training and glide into your practice you cannot avoid being associated with people younger and older who share your goals and respect your ideas. You will as well encounter people or groups of them that disagree with you or do not share your ideas. This is a reality, so one must deal with it, as it cannot be avoided. Be solid with your beliefs, stick to the truth, seek the happy compromise. You cannot please everyone, so at least try to get along with everybody.
Ninth, your patients are children of God just as you are a child of God. Behave like one and treat your patients accordingly. Respect their dignity, their humanity. This we must do always, even in the face of Medicine’s commercialization and the degradation of the doctor-patient relationship by businessmen and corporations. When we were graduating medical students twenty-five years ago I read an article in the New England Journal of Medicine foretelling the invasion of health maintenance organizations and managed care into medical practice and how it would affect the doctor-patient relationship. Indeed it is upon us, and twenty-five years later, the value of the care you give your patients has been commoditized into price schedules that doctors have to subscribe to. Doctors are no longer as independent as they once were, as they rely on patients provided by these HMOs for sustenance. With this reality what are you young doctors to do? Becoming financially savvy is not a sin to a doctor. If corporate middlemen have taken over medicine, doctors can just as well take it back from them. Become medical entrepreneurs. Organize yourselves. Get into business courses. Learn accounting. Learn how to read a financial statement. Doctors are inherently trusting people, and this is taken as a motivation for their deception by marauding businessmen. Your clinical-technical knowledge, skills and attitudes should not only be your equity on the business table when dealing with corporate medicine. One must be adept at finance, accounting, and management as well.
Tenth, let Jesus live in your heart forever. La Salle students implore this at the start and end of every classroom session. The answer to the question “What would Christ do if He was in this situation?” should animate your everyday life. Pray and desire Jesus always remains in your hearts, despite the humdrum, the everyday routine, the stress, the challenges, the sorrows and joys of doctoring.
Congratulations to the Class of 2010. Enjoy the rest of the evening. Thank you and Animo La Salle!
