Moonman Blues [ARCHIVE]

This is an attempt to join the latest fray. The PC in the title is not the personal computer but the acronym for Political Correctness. Because PC is almost totally legislated in the US, it is hard not to encounter it. In my work place, I find a lot of ‘Equal Employment Opportunities’ banners and information on discrimination displayed on counters and posted on bulletin boards. Job discrimination is a major facet of PC but it is only one among several.

Obviously, this post is sparked by the persistent drone of the illegal immigration issue. I avoid going into that specific topic, so let me limit myself to the PC issue. In one episode of the show ‘The Big Idea‘, the question posed was ‘Is America Too PC?’ The host and guests never did get a consensus but the discussion was intense. In other news, one school in Denver has banned clothing that makes a political statement. For the principal, national flags and patriotic colors are political statements. They probably are, but, come on, let the students wear what they want as long as they look decent. Another school in Virginia sent 2 kids home because they wore shirts that read ‘Latinos Forever’. What would happen if some Fil-Am kid comes in with a shirt that read ‘Pinoy Ako’?

To go beyond the influence of the illegal immigration debate on PC, let me cite 2 examples of PC prior to all the brouhaha.

Example 1: My wife and son were in line to buy pretzels in a mall. A white lady was standing behind them. My son and wife were discussing (or arguing) what they should get so that they’d be ready when it’s time to order. Standing a few paces to the right, I could see the lady look at my son and wife and make a face of disapproval. She even rolled her eyes.

Example 2: Two of my friends, U and G, were talking in Tagalog in an elevator in Vegas. U has lived here for almost 8 years and is already a US citizen. G recently had his petition approved and arrived a few months back. When someone steps in the elevator, U would shift his language to pure English while G continued to answer him back in Tagalog. G then asked U, ‘Bakit ka biglang mag-e-English kung may tao?‘. U then explained that many people find it rude and offensive to hear other languages aside from English. G didn’t bother a follow-up. He just thought it weird why people would be offended when they’re not even part of the conversation.

In the first example, there is intolerance of the unfamiliar. In the second, there is fear of offending someone totally uninvolved in the conversation. I find both instances laughably sad. Both actions–the disapproving look and the sudden change of language–should have been totally unnecessary. While the US continues to hoist the flag of ‘celebrating diversity’, political correctness dampens any expression of it. Is it only okay to be different as long as it doesn’t offend the sensibilities of the harshest critics? Anything and everthing is bound to offend someone. We can’t help who or what we are–and if that something inherent and almost unchangeable in us offends others, it shouldn’t be our problem.

The capacity to tolerate diversity–much more celebrate it–comes from the true ability to appreciate individuality. A person incapable of respecting differences should not be allowed to define the boundaries of political correctness. Come to think of it, political correctness may actually ask people to tolerate the intolerant.

In the first example, why did the white lady disapprove of people talking in a different language? She just might have a bias against Mexican Spanish and misconstrued Tagalog as Spanish. My wife was once told by an American mother that she didn’t want her kids watching ‘Dora the Explorer’ because it has Spanish. But a lot of Americans find the French and Italian languages or accents romantic and exotic. Go figure. In the end, my Filipino wife ordered in English to a Mexican cashier selling American pretzels.

In the second scenario, I have to side with G. If they maintained basic courtesy, e.g. not talking loudly or shouting, then there should be no need to suddenly shift to Tagalog. People who are not part of the conversation should stay that way. Why should foreigners compromise their beloved language for the benefit of strangers listening in?* It doesn’t make sense. But PC sometimes doesn’t always make sense.

Respect and tolerance–these should be the mantras of PC. Respect for individuality. Tolerance for the different. PC asks people to open their minds to the new and unfamiliar; it doesn’t demand others to conform to personal norms. The boundaries of PC is defined by the edges of freedom and responsibility, and not by the margins of the thinnest sensibility. People shouldn’t tiptoe around their identities or nationalities for fear of offending someone.

As Yoda said, ‘Fear leads to anger. Anger leads to hate. Hate leads to suffering.‘ And, remember, it’s always politically correct to quote a Jedi.

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* On a side note, let me just say that talking in your own language can be rude if you are in a small group. I once joined 3 of my co-workers for lunch and they were all Chinese nationals. All throughout they continued to chat away in Chinese. Although I was able to squeeze in a few questions and sentences, I felt left out. Poor me. But the food in the Vietnamese restaurant was superb.

Randy David, in his Philippine Daily Inquirer column, offered with obvious hesitation an explanation for the tendency of Filipinos to immigrate to other countries. In The shift to nursing, David states that “(t)oday’s immigrants are different. They seem more desperate about being able to find a future at home… Many have reached a point of indifference… No one inspires them anymore… They refuse to waste their youth in a society that offers them nothing on which to anchor their hopes.”

He concludes by writing:

I am sure there are many deep personal reasons behind the current exodus of our people. But I think of it as societal entropy. A term from thermodynamics, entropy refers to “the amount of energy unavailable for useful work in a system undergoing change.” Applied to a society, it is a measure of disorder in the system. In plain language, it simply suggests that the present system in the country is such that it can no longer absorb talent. That’s one way of looking at our problem.

I understand Randy David’s point on societal entropy. It results in a restless society trying to find places to fit individuals in need of usefulness. Despite the common assumption that patriotism is dead in Filipino immigrants, only a few immigrants I’ve talked to will agree. A lot of them look back to their motherland with bittersweet memories and know in their hearts of hearts that if there was an easy choice of going back, they would. But several of them have found ‘their place in this world’, finding a usefulness that benefits their direct and indirect families back home. And anything that benefits ‘people back home’ benefits the beloved country.

I do not agree, however, with his paraphrased suggestion. It is not that the country can no longer absorb talent, it is that the country prefers to absorb personalities rather than talent. We now have a country that values popularity more than intelligence, surveys more than debates, press releases more than long-term platforms. Gone are the days of Claro M. Recto, Ninoy Aquino and Jovito Salonga, where politicians were popular because they were good leaders. Now, we have government officials who became politicians because they were popular.

Our country has a severe ‘personality disorder’. It is a systemic problem that puts actors, rehashed politicians and sons and daughters of political clans in positions of power. That is why we have criminals making our laws, nitwits formulating national policies and old hacks planning our new future. And, despite the widely-held belief summarized by Joseph de Maistre that ‘every country has the government it deserves’, some will not sit still in silent desperation. A government that doesn’t serve its people deserves to lose them.

What follows is a comment I made in a blog post entitled Blogs, revolutions, change and critters.

Hmmm…change is inevitable. That’s a good start. It reminds me of high school and Jonathan Livingston Seagull.

However, beyond the inevitability of change and categorizing it according to onset, there are still lots to explore when talking about societal changes. There are several considerations, e.g. purpose, effects and control.

There is such a thing as purposeful change and society is–and should be–capable of that. Change should not be done for the sake of change. Just because it is inevitable, it doesn’t mean it can’t be harnessed. There should be a reason to change aspects of society within our control. Theories of management consider purposeful change a vital part of strategy.

The effects and repercussions of change are also important when writing about it. There are bad and good effects of change, So, in simple terms, there are ‘bad’ and ‘good’ changes. And some of these effects cannot be appreciated immediately. As you mentioned, the effects of the 2 EDSAs are still debatable.

Control is a crucial factor for societal changes and for those who want to initiate them. You have to know what you can and cannot control. This reminds me of the Serenity prayer. However, the discerning change master should exert efforts to widen his circle of control.

Anyway, there are books that explore these facets of change to help push the topic to a whole new level. I especially like the ones that deal with ‘creative destruction’–an abrupt process where companies destroy organizational foundations to improve performance–and ‘constructive discontent’–a slow process where organizations build on top of existing changes. Peter Drucker wrote extensively about both topics, while articles from Fast Company discuss how Social Capitalists–NGOs that succesfully initiate change through business skills–employ the last one to produce results.

I guess there is not enough space for more intelligent discussions. The concept of revolutions is another tricky topic. A good discussion would be about quiet revolutions–how they happen, how they can be initiated and how they can be controlled. Malcolm Gladwell in his book, The Tipping Point, discusses the factors that bring about epidemics and quiet revolutions.

Now, some good questions to throw out are: Is change truly inevitable? What happens if you stop change? Better yet, what happens if you succeed in stopping change? Wouldn’t stopping societal change cause that society to change?

Change is a spectrum. We should not look at change and status quo as black and white. Just because other people don’t agree with the changes you want, it doesn’t mean they want the status quo. It simply means they do not agree with the changes you want.

Another point is who should play the role of change master? This is important for revolutions. Democracy works best for people who fought and died for it. Apply this thought now for the 2 EDSAs, the US against the British, and today’s Iraq. Who initiated the changes, who benefited from it, and how long did the change last?

The inevitability of change is one thing; initiating change another. As George Bernard Shaw said, ‘The reasonable man adapts himself to the world; the unreasonable one persists in trying to adapt the world to himself. Therefore, all progress depends on the unreasonable man.’

Doctors are concerned about three legislative proposals on the Senate floor that attempt to protect the rights of patients against errant doctors. One bill even mandates practicing physicians to secure medical malpractice insurance at the risk of losing their license. Various medical organizations, including the Philippine Medical Association, shared their protest through newspaper commentaries and position papers.

It has been proven in the United States that medical malpractice insurance promotes the practice of defensive medicine. This increases the cost of health care because doctors ask for procedures and tests to cover all bases. Legislators insist their bills benefit the Filipino people who they allegedly serve.

It is imperative to put things in proper perspective. The Philippine Health care system is a mess, plagued by one problem after another. In the private sector, many big hospitals operate on ballooning debts and are always on the lookout for capital infusion. Provinces and urban outskirts are lined with small private hospitals that are forced to increase prices to cover operational expenses. These hospitals work with outdated laboratory equipment and fast employee turnovers. Despite the proliferation of Health Management Organizations (HMOs), overall private health insurance coverage is meager. Important procedures and prolonged hospitalizations are either not covered or beyond prescribed limits.

The public sector is much worse. The devolution of the early 1990’s forced provincial and municipal hospitals to collapse under small budget allocations from their local governments. Many operate on skeletal crews while occupancy rates and average length of stay continue to increase to inefficient levels. Many regional hospitals don’t meet secondary or tertiary hospital standards. Primary hospitals are reclassified to infirmaries because they can’t keep with costs. Busted and outdated equipments are common. Most laboratory and diagnostic tests are not available and brought outside to private laboratories. Some municipal hospitals can’t afford an 80 thousand peso ECG machine, while mayors drive multi-million peso SUVs. PhilHealth has yet to achieve wide insurance coverage, but with the continued exodus of health care professionals, patient coverage is moot.

Health workers in both public and private sectors are overworked and underpaid. Several rural health units don’t have nurses and doctors. Several local governments are tapping the traditional health workers—hilots, ambularyo, panday—to augment the lack of basic health services. National health programs, e.g. Anti-Tuberculosis and Family Planning, are either underfunded or mishandled. Medicines and supplies are either reduced or stored in warehouses to rot. The Department of Health is hard put at funding and finding doctors for the Doctors to the Barrios program. The whole concept of primary health care is hinged on the work of non-government organizations where unbelievably more results are expected than from local government and health units.

Despite these distressing scenarios, our legislators find it compelling to look at protecting patients from a few—as they say so in the proposals—errant doctors rather than creating laws which bring back basic health care services to the people. With so many problems to tackle, it is mind-boggling how Senators find time to look at increasing liabilities for medical personnel. It seems that patients need protection from the government more than they need it from doctors.

The son of a stroke patient called up my wife to ask her to see his mother at his house. This surprised my wife since she thought the patient was in the community hospital under the care of a neurologist. My wife, the dedicated doctor that she is, decided to visit the patient even if it was way past midnight. And the dedicated husband that I am can’t do anything but drive for her. We woke up our 3-year-old son, dropped him off at my wife’s parents and went to the patient’s house. My wife went in and I stayed in the car.

After an hour, my wife came out with a story. The son brought the patient home against medical advice because they can no longer sustain the hospital costs. While at home, the patient fell off the bed unnoticed until late at night. The family called my wife to make themselves feel better. They vehemently argued against going back to the hospital. They didn’t have enough money for prolonged hospitalization especially for an illness with a poor prognosis. My wife couldn’t do anything but check the status of the patient, review the prescribed medications and comfort the family.

‘That shouldn’t have taken an hour’, I said. Well, it so happened that when my wife arrived, a faith healer was there with the patient. Apparently, the son called up a faith healer and a doctor to make sure all bases are covered. My wife had to wait for over 20 minutes as she witnessed some of the faith healing procedures involving a piece of paper, several leaves, some stones, and a lot of loud murmurings.

‘Binayaran ka naman?‘, I asked.

‘Two hundred pesos. Five hundred daw sana kaso three hundred daw singil nung faith healer.‘

And that is where our government has driven Philippine health care—where patients and relatives have nothing working for them except loud prayers and cheap science; where the poor are asked to choose between food and medicine; where dedicated doctors compete with patient resources and quackery. The government doesn’t seem to realize that the Philippines is a third world country. It is a poor country where doctors frustratingly practice the art of palliative medicine, where most diseases are addressed when it is too late, where preventive medicine is an idea found only in textbooks and government pamphlets. Doctors scream silently as they give their prescriptions and see their patients hold that piece of paper with a heavy heart. With the continued increase in drug prices, writing prescriptions are exercises in futility as the government drives people to deepening levels of poverty.

When patients teeter on the edge of sanity to make ends meet, it is ludicrous for legislators to waste precious time addressing the needs of special interest groups. With the continued loss of health workers to other countries, it is stupid to squeeze small financial gains from doctors who stay. When patients die from lack of primary health care services, it is callous and heartless to spend public funds keeping seats warm in government.

The patient should always be the central benefactors of health care. And I do not deny that medical errors exist. But patients do not yearn for complex laws, they yearn for basic health services. They do not ask for mandatory malpractice insurance, they ask for affordable health insurance. They do not deserve defensive medicine, they need preventive medicine.

With obscene spending and misplaced priorities, government is bent on pushing health care way below humane levels. The continued persecution of physicians is a nail on the patient’s coffin. Malpractice is not the problem, malgovernance is.

An original Pinoy.MD Article

“Do you know George—George Abbott?”, my mentor asked me. We were in a restaurant doing some calculations on the bill.

“Nope, who’s he?”

“He manages Abbott’s Cafe, the cafeteria inside our building. He calculates all prices and taxes in his head.” I didn’t say anything but my face shouted out, “Why the heck would he do that when he’s got a cash register?”

“He’s blind. Don’t worry, you’ll see him one of these days.”

That was more than a week ago. I’ve seen George Abbott since then. As it turns out, he’s not only the manager, he’s also the back up cashier. Everytime he mans the register I can’t help but be amazed. People have to say what they bought, “Medium coffee with extra cream and a blueberry muffin”, and George deftly swooshes his hands on the register and the total price is shown. Then, people say the amount of money they put out, “Here’s a ten, George.”, and George types that in and the change is displayed for the buyer. The cash register opens and George instinctively knows where each paper bill is and where each coin should go.

At first I avoided him, falling in line at the other cash register. It can be a comfort to simply show the items to the cashier and pay the amount shown. No words exchanged, only some gestures and money. Most of the time I don’t even know what I’m buying. I bought a chicken lunch once only to find out it was fish—which didn’t matter to me because they all tasted the same anyway—bland.

But one time, there was no other cashier. There was only George. Good thing I just got a small cup of coffee.

“Can I help anyone?” His greeting was always cheerful and open, whether there was someone in line or not.

“Umm… I have a small coffee, George.” I said with hesitation. “And here’s 5 dollars.” I touched the paper to his hands. He took the $5 bill, ironed it out some, and placed it in the register. With rough dexterity, he fished out several coins and four $1 bills and handed them out. I grabbed the change and said thank you.

As I was about to leave, he said, “Enjoy your coffee. Can I help anyone?”

Yes, George, I will enjoy my coffee. And no, George, I was the only one in line. After a few steps, I looked back and found him still standing there. What else would a blind man do by a cash register? After a minute or so, he’d call out, “Can I help anyone?”

It must be hard to put too much trust in people. Someone can give a dollar and say it’s a hundred dollars. They’re both paper and George wouldn’t know the difference.

Still, I have to admire the man. In a place that rushes and buzzes, he stands by in his place offering help to anyone. I’ve come to believe that his trust in people didn’t come from necessity. He knows, given a chance, people will act with decency and honesty. He has a strong belief in the basic goodness of people.

In a cafeteria somewhere in America, a blind man gives every person in line an opportunity to step up and renew the goodness in themselves, a chance to know they are better than they believe. The simple act of buying coffee becomes an exercise of integrity. And just because George had some faith—some simple blind faith.

The ‘Sell Out’ stigma has since died down. It is now a footnote in the obscure pages of Philippine medical history. But the exodus continues and the situation is a fierce topic in conferences. Even business schools have taken up the issue and debated on the reasons of the plight and flight of doctors and the effects on the public administration of health care. And the conclusion has taken a gentler form. No, they now agree, doctors didn’t sell out, they just gave up fighting.

And what are they fighting for? Among other things, doctors—and other health workers—fight for better pay and better working conditions. They fight for protection from bogus health companies and quacks in government. They fight for stronger organizational leadership. They fight for a better government. They fight for their patients. They fight for their families.

It is a sad fact that bank tellers and call center agents get better pay than general physicians in HMOs and residents in training. Bank tellers may get as much as P15,000 per month while GPs get P9,000-P12,000. Call center agents get as much as P21,000 per month while residents in private hospitals are lucky to get anything over P10,000. People who handle money and customer service get better wages than those who handle lives. This says much about industry standards, whatever that means.

But isn’t it true that all Filipinos are fighting for higher wages? Yes, but the fight is done in different ways and have different effects. When factory workers stop working, production goes down. When jeepney drivers wage a strike, transportation grinds to a halt. But when doctors go on strike, patients die.

I have seen doctors fight for a collective cause. They threatened work stoppage at a small private hospital unless conditions for better pay are met. They gathered just outside the emergency room and carried placards and signs. But the whispers and conversations within carried in them the futility of their efforts.

‘Tawagin mo ako pag may dumating na pasyente.’

‘Akyat muna ako at mag-a-assist ako sa OR.’

‘Sandali lang, andyan na yung follow-up ko.’

These are phrases uttered by the doctors on strike. Even the venue of the strike is crucial. They to sit it out in front of the emergency room and scramble in when an emergency case arrives. Once the patient is stabilized and brought up to the floors, they then trickle back into the strike area, anxious and ready for another case.

Doctors are not immune to the effects of graft, corruption and poverty. Some doctors are unemployed, while others take double or triple jobs. Many doctors look outside the field of clinical medicine for extra income. Some are into related fields like academics and research, while others go beyond medicine and venture into medical transcription, nursing, information technology and selling jewelry and health insurance.

Not everyone has government officials and actors for patients. In Batangas, moonlighting specialists settle for P1,000 for normal deliveries and P3,000 for caesarian sections. In the provinces, doctors are often faced with poor patients—and rather than exacting consultation fees, most instruct the patients to just buy the prescribed meds with what is left of their money.

Doctors are pinned to the wall. If they fight back, people die. But if they don’t fight back—well, they go home tired and weary. In any case, the health of Philippine society hinges on the Filipino doctors’ sense of decency—the decency to put the patient first—above anything and everything, even their own needs.

Hospitals and managed health companies exploit this sense of decency to a fault. They know doctors will not abandon patients. Yes, some paper work will be delayed if work stops, but they have administrative clerks for that. Patients will still be treated, surgeries will still be performed, follow-ups will still be done.

So, how will doctors fight back without hurting their patients? How will they go to the streets and protest unjust compensation? How will doctors fight unseen ghosts and forces that threaten to push them to acts of indecency and selfishness?

By bringing the fight closer to home. Everywhere doctors are questioning the choices that lay before them. While society continues to flourish in the notion that doctors get full satisfaction from public service, doctors struggle to face the harsh reality that life is full of shit. There are no right choices, just promises and responsibilities to keep. There are no wrong decisions, just consequences and the courage to live with them.

The fight to leave or stay—and yes, it is a fight—is not found in the loud voices on the streets and the echoing chants in demonstrations, but in the grave discussions at dinner tables and the whispered conversations when the children are asleep. Because doctors are slowly finding out that living—and leaving—for one’s family is a battle worth fighting for.

For some, it has come down to choosing between loneliness and poverty. Some choose to be lonely, while others choose to be poor. Doctors are not leaving, they are driven away. And these doctors carry their own personal battles in foreign lands, where they fight extreme depths of loneliness and immense levels of uncertainty. Those who stay fight their own battles of survival, where each day is a search for some sense of meaning in the care of other people’s lives.

In the gloom spreading all over the country, people are asking for a chance to get past poverty, a chance to make a difference, a chance to rise above the muck of helplessness. In the current state of desperation, people are looking for a fighting chance. And everybody deserves a fighting chance—even doctors.

Obviously another Pinoy.MD article.

Doctors are leaving. We’ve read the bitter reviews, the harsh editorials and the sensational news. Filipino doctors are packing their bags and taking the next flight out of the country. It doesn’t matter where or as what. The bottom line is that they’re out of here—and Philippine society is angry.

It’s easy to lump individuals into professional categories: doctors, specialists, general practitioners. When headlines shout “Doctors are leaving”, it conjures an image of a crowd in a cinema running and fighting their way to the exit as if a fire just occurred. In this instance, it doesn’t matter where you end up as long as you don’t end up dead. Anywhere but here, as an old saying goes.

Is this far from the truth? I honestly don’t know. I only know that there are familiar faces in the crowd: classmates, friends, teachers and mentors. And they are not running. They are sitting silently in the corner, deep in thought but ready to make their next move.

My friend told me a story once. He was in a Florida club with a white female friend. This was just after he passed the local boards. A white dude came up to him and insulted him with racist remarks. His female companion defended him, saying he was a Filipino doctor. The dude just had one thing to say to my friend, “So, what does that make you HERE?” My friend replied, “Nothing. That makes me nothing at all.”

It is a true story. Sad, but true. It also drives the point that some doctors, when they leave for other countries, may also be leaving their hard-earned degrees. Ten years of sleepless nights, stressful days and neck-breaking hours in between—all down the drain.

Only a few understand the rigors of medical training. The prized M.D. degree consumes almost 10 years of a person’s life. If you add residency training, by the time the new specialists graduate, they’d have spent half of their lives going after a goal—to be a doctor.

But beyond the time and the labor, fewer people understand the support behind every medical student or resident physician. For many, medicine is not an individual goal; it is a collective dream—nourished by fathers and mothers way before medical school. Nobody survives medical school or residency training without moral and financial support.

We know the stories: an OFW in Saudi cannot go home until his daughter becomes a doctor; a caregiver in Canada continually sends half her income to pay tuition for her brother in med school; a government employee foregoes retirement to fund materials and equipment for her son in residency training. There is no dearth of stories, as each will have his own. Behind one doctor’s dream is a collection of family sacrifices—family sacrifices that may have to be paid in full.

It’s not surprising new physicians or specialist are running up and about, ready to put all their training to use. They need to earn. Let me repeat that, they need to earn. With a certificate in one hand and some idealism in the other, they stand at a crossroads.

Doctors practice their trade wherever and whenever they can. Some go home to their provinces, while some try their luck in urban centers. Some take up additional training, while some set up small clinics. Some apply for admitting privileges in hospitals, while some get affiliations from HMOs. Working hours may start as early as 5 am and may end as late as midnight.

But at the end of the day, in the confines of their own homes, they hang up their stethoscopes and tuck away their degrees. They watch the news and eat stale dinners like everyone else. They play with their kids and put them to sleep like everyone else. They go to bed tired and weary like everyone else. Because at the end of the day, these doctors are not doctors. They are fathers and mothers, sons and daughters, husband and wives. And much like everyone else, they worry about their future and their family’s future.

As the exodus continues, Philippine society will see doctors leaving careers and patients behind. But in the confines of homes in different parts of the country, we see fathers and mothers leaving families behind, sons and daughters saying goodbyes, and husbands and wives praying for a bright future. At the end of the day, we are not losing doctors, we are losing loved ones.

Almost a year ago, my good friend told me he was leaving for Trinidad and Tobago as a UN Volunteer Doctor. I didn’t ask about his career, his degree or his plans. The only question I asked was “Paano anak mo, asawa mo?” And with a long sigh and a short smile, he answered, “Para sa kanila naman ito.”

And that is where many doctors find themselves at. With a plane ticket in one hand and a good dose of reality in the other, they stand at a new crossroads—where paths lead to faraway places and foreign countries, where the only things they can bring are what they can fit in their hearts, and possibly some pictures in their wallet.

I may soon find myself standing at that crossroads—falling in line and holding that crisp boarding pass in my hand. But I don’t dread the day some white dude would walk up to me and say, “So, what does that make you HERE?”.

It makes me a father. At the end of the day, in the confines of my rented space in a foreign land, my son is more important to me than a piece of paper hanging on a wall.

Originally posted in Pinoy.MD.

By now, everybody knows of Elmer Jacinto–the February medical boards topnotcher who publicly announced his plans to work in the US as a nurse. I was in Zamboanga City visiting my parents when that news broke out. A topnotcher from Lamitan, Basilan hit close to home and I showed the article to my brother. His only question was, “Why? Doesn’t he have any offers?”

I could only laugh and muster a short, “No, I don’t think so.”

Elmer Jacinto’s situation and the reactions from various sectors are both funny and sad. I can only think of my brother’s question and wonder: What can the country offer its best and brightest in the medical profession?

The short answer is none.

Unlike the legal profession, of which the medical profession is often compared to, there are no offers made to topnotchers. We’ve read news of bar topnotchers invited to join prestigious law firms. Top law graduates are employed even before the bar results are released, while some receive hefty signing bonuses from happy employers.

Medical board topnotchers are not that lucky. After a day or two in the light of fame, most fall back to the shadows of anonymity–their achievements a mere footnote in their résumé. We hardly remember the board topnotchers of the previous years. How many of them are practicing in the provinces, much less in the country? Can you just imagine the public outcry if we found out that only a few have stayed?

Therein lies the problem–the public outcry. Why is the public so pent up about doctors going abroad as doctors or nurses or caregivers or whatever? Because my short answer is not exactly correct. The country does have something to offer the graduates of the most noble profession: the poor and sick of the Philippines. Physicians, especially new ones, are expected to grab the opportunity to serve–for a pittance of a fee, or even for free.

I tried my hand in volunteerism once when I was “in between jobs”–or, in short, unemployed. Living a few blocks from the Malate Parish, I volunteered my services to their social services division for one day a week. I scoured the streets of Manila for jobs on Mondays to Thursdays, while I devoted Fridays to the urban poor of Malate. They gave me an old desk in the small office at the back of the church. The social worker announced my presence to community leaders, and, in no time, I was seeing 10-15 patients a session, which isn’t exactly heavy.

It was a fun experience. A patient wanted me to give him a medical certificate stating that he should sleep on cement benches because it was good for his back. He was supposed to show this document to police officers of Luneta where he spent his nights. Another patient, a jolly 80/M, went to see me not for a check up but to show off that he was in perfect physical health. He would do jumping jacks and push ups in front of me.

It was also a time of desperation. A stroke patient, with half her body paralyzed, persistently showed up every Friday, limping her way through Manila traffic. She continued to have a BP of 200/140. Another patient had a resting systolic BP of 220-240. The list goes on. And I could do nothing but prescribe the cheapest anti-hypertensive. But they all had the same excuse: they didn’t have the money to buy the drugs.

Not willing to lose a battle, I wrote the Parish for some support, financial or otherwise. I was asking for some drugs, about P800 worth, and a P500 money pool, in cases of emergency. And they replied that they can’t contribute at the moment since they’e finishing the wing for the missionaries, putting in a library and airconditioning. I kid you not! I wrote a short letter to the city government, but they said all health support should go to the local health center.

One Sunday after mass, the parish social worker informed me that the Rotary Club of Manila was conducting an outreach program. I went with her and talked with the President of the club. They agreed with the whole package, insisting only that I submit proper accounting reports every month for their newsletter. I can’t say it was smooth sailing from then on. It definitely helped me with some of my patients, monitoring for drug response rather than just looking on helplessly.

My experience is not unique. Volunteerism doesn’t have to be so obvious. Surgeons forego professional fees after operations, internists accept P20 for consultation fees, pediatricians charge break-even for immunizations, and general practitioners accept eggs and chickens in exchange for services. These may be small acts, but they are by no means less heroic.

There are, of course, doctors who work with the poorest of the poor. Volunteer doctors to the war-torn parts of Mindanao would have different stories: their experience, more colorful, their desperation, more intense, their helplessness, more personal. Their dedication is a strong testament to their character. These doctors who work with the poor often become poor themselves, and I have nothing but the utmost respect and admiration for them.

In all these cases, doctors are found in the frontlines of poverty. They work with almost no logistic and financial support. They carry the burden of salvation for their countrymen, with little or no compensation, with little or no thought of self. But the fact remains that mere presence can only do so much. What can a doctor give if he has none. aside from compassion and care? Is that really enough?

It’s ludicrous how the public expects too much of a sacrifice from Filipino doctors, when it expects too little from its government officials. The fight for better health is a fight against poverty. It is not won by doctors becoming poor themselves, but by government officials becoming the leaders they need to be. Doctors do not make laws, allocate resources, handle budgets, public officials do. Doctors do not get kickbacks, destroy public trust, and plunder taxpayer’s money, government scalawags do. So, when did doctors become sacrificial lambs for the ineptitudes of Philippine government?

The public flogs physicians, living on P10,000 a month, who pack up and go to the US as nurses, when they pay no mind to regional directors, earning P22,000 a month, who go abroad as tourists for weeks at a time. People look suspiciously at doctors driving a brand new Toyota Corolla after 5 years of practice, when they find nothing wrong with mayors sporting shiny Ford Expeditions after 6 months in office. If we should mourn for doctors who leave, let us grieve more for corrupt officials who stay. If we should complain of doctors who dream of decent living, let us condemn more those unscrupulous government employees who lead obscene lives. Wounded souls search for healing in other countries, but there is no cure for callous hearts.

A mayor once asked me to join a free medical mission he sponsored. I humbly asked if there was any payment involved for my services. “Ah, eh, wala. Pero libre naman ang pagkain. Tapos ipapahiram ko naman yung Pajero ko at isa kong Starex para libre na rin yung transpo.”

I wanted to bitch-slap him until his lips bled.

This essay first published online in Pinoy.MD.

Frederick W. Taylor formalized the principles of Scientific Management. One of the important concepts of Scientific Management is the application of scientific methods, i.e. observation and experimentation, into work designs and operations. The theory also proposes breaking complex tasks into different subtasks and optimizing these subtasks to effect better productivity. With the identification of basic operational tasks and observation of efficiency, the theory suggests that it is possible to develop a “one best practice” for the different jobs and responsibilities involved in the operations of the company.

The identification of best practice allows the implementation of worker selection, training and development towards this specific goal. Thus, scientifically optimizing the parts creates an optimized whole.

The theory, however, ignores the human and dynamic side of organizations by concentrating on the efficiency of the moving parts, i.e. workers and machines, and their contribution to the overall performance of the organization. Scientific management focuses on job productivity, but is highly specific for manufacturing and assembly industries.

Scientific Management can be instituted in healthcare where responsibilities are tagged as routine or monotonous–and where standard operating prcedures are applicable. These tasks should be repeatable and involves minimum personal judgment. These include, but not limited to, transport of patients, hospital bed management, dietary operations, public health surveys, information dissemination programs and personnel training and development.

Henri Fayol was a principal contributor to the Administrative Theory of Management, which attempted to develop principles and guidelines for administrators and managers of organizations. It emphasized the personal duties of management and described 5 primary roles: plan, organize, command, coordinate and control. It was unique in that it tried to define management as a separate but integral layer of the organization.

Fayol also developed 14 principles of administration to go with the 5 roles. The most interesting principles are Unity of Direction, Initiative and Esprit de Corps. Unity of direction compels the manager to communicate the common purpose of the organization to the workers. Initiative challenges the manager to allow creativity in job performance. Esprit de Corps requires the manager to recognize the value of teamwork.

Administration Theory differs from Scientific Management in that it expects efficiency and productivity from the top management to dictate performance in the rank and file workers. Applications in healthcare involve the local health unit leaders up to the Department of Health administration.

The Human Relations Management Theories stemmed from Elton Mayo and his work in the Hawthorne Studies, although Mary Parker Follett, a psychologist, was a major contributor. In short terms, it applies the field of psychology in the management of workers and the organization.

This theory takes into account the organizational environment and social context of management and workers. It puts focus on people and the interpersonal relationships that develop in work conditions. Trust, group dynamics and personal productivity are believed to be among the most important factors in creating an efficient organization.

Two major differences of this theory as compared to the other two are the concepts of motivation and job satisfaction. Motivation should be directed toward teamwork and group dynamics–and it should go beyond economic incentives, as the Scientific Management proposed. Job satisfaction involves understanding a common purpose and a sense of belongingness for the team, thus for the organization. It also involves the idea of making workers feel they contribute greatly to the progress and growth of the organization.

The Human Relations Management Theory probably has the most impact in healthcare considering that patient care exacts some emotional burden on health workers. It is important to understand how an individual reacts and responds to a given work condition and how groups and teams help overall performance of health units. It is important to consider that healthcare teams do not only provide better services to patients, but it also provides moral and physical support to the members of the team.

(Note: This is from an assignment I made for my Public Health Administration (HPAd 201) subject. Sorry… I just had to post something on the blog.)

(The Unofficial Guide to Looking for blues in your Local Music Store)

In the early 90’s, it was difficult to find blues music. I scoured and raked the stocks of local music stores—and almost resigned myself to being a bluesman with no blues music. In a way, I’m thankful that Makati decided to go global. But if you find yourself miles away from Tower Records or Music One, or you’re just itching to get your ears initiated to the blues, read on.

What is the blues?

The Mother of Modern Music—that’s what some musicians call it—greatly influenced jazz, rock and roll, country, pop and R&B. Beyond its technical description of a 3 chord song with I-IV-V progression, the blues is also a sad story, a lost feeling, and a starter philosophy with no ending. Once labeled as the Devil’s music, blues purists are quick to point out how music with such soul and heart, such life and vigor can come from the depths of hell.

I first experienced the blues when I accidentally heard Jimi Hendrix dish out “Red House” from an old tape deck. I was hooked. The “Blues” and “Woodstock” albums, both released after Hendrix’s death, are surprisingly easy to find until now, although mostly in tape format. The acoustic version of “Hear My Train A-Comin’” is one for the books. Its riffs and licks can tear an acoustic guitar to shreds. I’ve tried it, I know! Although notable acoustic songs exist, Jimi Hendrix is better known for electric, over-driven and amplified blues. His songs are staples in local blues concerts and festivals—and it’s almost never blues without them.

If you don’t like seeing purple haze when you listen to music, another option is Eric Clapton. What? Eric Clapton plays the blues? Yes. To some, Eric Clapton IS the blues. Propelled to the spotlight by “Tears In Heaven”, his “Unplugged” album is a bluesman’s feast. With performance stripped to bare essentials, the acoustic sound is crisp and sweet, the voice honest and soulful, and the blues raw and traditional. No wonder this live recording earned six Grammies. “Before You Accuse Me” and “Running On Faith” are two of my personal favorites. “From The Cradle” is another album worth having. Like most Clapton works, these two are widely available.

For a full dose of the blues, nothing beats a B.B. King album. Tagged as the “King of the Blues”, B.B. King brushed mainstream music with the 1994 “Deuces Wild”, a collaborative album featuring pop stars like Van Morrison and the Rolling Stones. Famous for his creamy, full-bodied tones and often slow electric blues, King seriously championed the cause to bring the blues to the media marketplace. Because of this, his solo albums are often available. His expressive blues is often cited as a major influence in the musical talents of Jimi Hendrix, Eric Clapton and Stevie Ray Vaughan.

Another collaborative album, “Riding with the King”, features Eric Clapton and B.B. King side-by-side with deep respect for slow grooves. The voices and the guitars, distinctly unique, work in tandem to deliver a masterpiece.

I’ve Got The Blues

Collections and official movie sound tracks are also good sources for blues music. Check out the rock or instrumental sections for rare finds of electric or acoustic blues. The movies “Blues Brothers” and “Blues Brothers 2000” featured well-respected blues artists, while the OST of
“City of Angels” contains songs from Jimi Hendrix, John Lee Hooker and Eric Clapton.

This article is by no means a definitive guide to the blues. Blues is too personal a music genre to be confined to lists and compilations. It was my intention to start you off in the right direction, what you do in the House of blues is all up to you. Pick your music, stick it in your player, dim the lights and close your eyes. Enjoy the stringed emotions and voiced passions. It’s just that kind of thing you do when you’ve got the blues.

This article was originally published in an issue of The Reviewer magazine.