New Year's Eve

Days will pass by until once again it is time again to return to listening to lectures and reading notes and memorizing a lot of information. During the vacation there were rituals to attend to like feasts, gift-giving and going to mass.

Well, it's not like I can instantly say that I don't believe anymore. Given our country and it's religiosity, you really can't be sure how open the reaction of people will be. So far, I haven't encountered any negative reactions. Let's just say for the sake of my own safety and sanity, I've decided not to divulge my current belief system to the family. But the funny thing; I don't find going to mass a drudgery. However, honestly my mind was blank during the entire service.

But then, why do we do these rituals? One can say there's a cultural, social and psychological reason for these rituals even though we think of them as drudgery. For instance, the typical Catholic mass. It's the same readings all over again. There's even a scheduled reading for a particular day. Yet many Catholics go to mass again and again. One can say they've been conditioned given the early indoctrination but that's more of a psychological reason; something not in the scope of this essay.

And then there are my rituals. In a regular day (Monday to Friday) it's: 1)go to class, 2)sleep in class, 3)eat lunch, 4)chat with friends, 5)go home, 6)eat dinner, 7)work-out, 8)read class transcriptions and 9)sleep. These sequence of events will vary if it's a weekend or a holiday but generally that's it. Pretty repetitive and simple and yes, boring. Yet why do I do it?

I'll venture a guess and say it's because of meaning. Now that's an overused word: meaning. You may have heard this, "what gives meaning to your life?" And well my answer to that would be the very rituals a person does during his/her lifetime.

Going back to the example of the Catholic mass if you really think about it, why would an

omnipotent and omniscient being demand worship from his creations. Of course, there is a convoluted theological explanation which I'm not going to place here because quite frankly I've forgotten it. Anyway think about it. What comes to your mind when a being demands worship? Dictators in the form of Mao, Stalin and Hitler. Worship would be a sign that that being is insecure because if a being is all-powerful and all-knowing and perfect why would it require impotent, ignorant and imperfect humans worshipping it? Do Catholics worship this being because they're afraid of its wrath? Then that makes this being no different from the aforementioned dictators.

So, at least in my view, Catholics go to mass again and again because it gives meaning to their own lives in the same manner my ritual gives meaning to my own life. Before I continue on, note that I am not discouraging Catholics from going to mass. It so happened I thought of using that as an example. If that's what gives meaning to your own life go ahead; just don't force other people to go with you.

On this New Year's Eve, think of the rituals you've done the past 364 days. Did you do them because
they add meaning to your own life or were you just forced? Were there some rituals you adopted because it became routine? Not that there's anything wrong with routine. But keep doing something everyday without pausing and thinking its significance; this action becomes routine. It is this becoming routine that unhealthy habits such as eating salty foods and a sedentary lifestyle becomes
ingrained and very hard to change. On the other hand, starting a work-out schedule is hard because of the opposite reason: it's not routine.

And I anticipate that one of the common New Year's resolutions out there would be to get fit. And expectedly, these resolutions would all fail because that person didn't make "getting fit" part of his/her own routine. The rituals one adopts reflects the meaning one attaches to one's own life.

The message is simple:

On this New Year's Eve if you're thinking of adopting new rituals and discarding old rituals you better re-define the meaning you give to your own life. You cannot blindly adopt a new ritual thinking you'll get the desired results without first re-defining your own meaning.

As The Year 2013 Ends

It's that time of the year again. After surviving 4 block exams; I have time to breathe a little bit. Well not too much because I have block exams approximately 10 days after the first day of class in January. And I have to say, I never thought I'd encounter so much difficulty.

For instance, I actually mourn if I get a grade that is low. I metaphorically flagellate myself and imagine I have brought intense dishonor upon the family name; just to give you a very clear picture. I have never done this in high school nor in college. Heck, in college, I'm satisfied if I managed to pass the core subjects. The major subjects come easily to me, for some reason. For the major subjects, I study until 9 pm the day before the exam. And that's it. But in here, I'd actually spend an entire day at a coffee shop reading and re-reading the class transcription and books. I would even maximize the 2 am closing time of said coffee shop.

My diurnal cycle is pretty much destroyed. Before, I easily get sleepy before 9 pm. Now, my minimum sleeping time is 12 midnight. Sometimes, it reaches 2 am. Of course, this means I sleep most of the time in class. At first, I'm embarrassed but as time passed by I can't help it. Sometimes the lectures literally sap your strength away. I'm not even sorry I snore; thankfully, my seatmates wake me up. And yes, one of my friends pointed out how stupid this is but my reasoning is that I earn so-called "guilty points". Meaning I missed the lectures therefore I have to spend the entire night reading and re-reading the transcriptions.

For the love life, well that's pretty much demolished as well. I mean I go out and meet people. But sometimes, I don't tell the truth. I don't tell that I'm a medical student and instead disguise myself as a yuppie. Sometimes, I even regret going to further studies because you're in different worlds. As much as you want to spend your nights and weekends boozing and cruising along Tomas Morato; you can't because it's either you have an exam coming up or you just want to sleep. And let's not forget the difference in intellect. It's a bit difficult meeting someone who can keep up with you in an intellectual conversation so sometimes you have no choice but to dumb yourself down or stay silent.

To be honest, sometimes I question why'd I'd gotten that revelation in the first place. Sometimes I doubt if I'm going to be an excellent physician.

But that changes when I meet patients. Well, at this point I'm not yet the one prescribing drugs or treatment. At first, I felt a bit intimidated because I have to speak in Filipino. Unfortunately, years of watching foreign films and my particular college have obliterated or at least made Filipino words coming from my mouth a bit awkward. And, I always feel anxious because there are some classmates around me and I think, I'm going to make a fool of myself. In short, my nerves always gets the better of me.

However, as time passed by with more patients and with more reading of Bates'; I've gotten used to talking to patients. Filipino will always sound awkward coming from me. Or sometimes, I can't think of the right Filipino word to say in that instant but I push through it. As the year progresses and my knowledge of diseases increases thanks hugely to Pathology; I more or less know what questions to ask and what signs to look for.

Doing a physical examination now comes a bit easier with more patients and more reading. Of course, the neurological examination will always be out of reach. Let us just say, it is so detailed and requires skill in hitting the nerve to elicit your deep tendon reflexes.

And oddly, it feels gratifying knowing the right knowledge and the right way to deliver it to potential patients. May it be a simple cold or a fever. I include the delivery because let's face it, we're dealing with human beings not rational creatures. There are times wherein being direct is not optimal. It may even force your patient not to face his/her diagnosis. So you really have to empathize with a patient. Not all patients are the same and it requires a highly skilled eye and an empathy sense to determine which approach to use.

As I type this, that is the reason why I keep fit: for the potential patients. For what use are you to a patient if you're the one suffering from a debilitating disease. It also increases your chances in getting a date but that's not my only reason. Well, of course it's not easy keeping a work-out schedule in the midst of multiple reading assignments.

So yes, there are lots of things I'd have to sacrifice and I hope I don't become one of those physicians who patients loathe. Also, I don't want to become the stereotypical physician who can't jog or even do push-ups yet will prescribe to his/her patients exercise.

In short, I don't want to become a hypocrite-physician.

Typhoons and Unbelief

The recent typhoon "Yolanda", international name Haiyan, has reeked devastation in the Visayas region. And the only thing I can feel when I saw the images, children drowned, people homeless, the entire city of Tacloban wiped out, is despair. As a human being I am deeply saddened by the meaningless loss of life. As a Filipino citizen, once again I am mad at the idiot in Malacanang following this news. He is totally unfit to be a leader but that is for another post. He is once again proving the need to correct the 1987 Constitution. Anyway, I digress.  

This is not going to be about how the typhoon could have been prevented by a benevolent and omnipotent god. It would be like rubbing salt in a recent wound. This would just be about how I felt and reacted to the news.

It can be summed up by a feeling of helplessness and hopelessness. I feel for the people affected by this super typhoon.

Which brings me to another point: how do I deal with religious patients. Currently, we are meeting patients and asking their history. One part of asking a patient history is asking for the patient's religion. There is a medical basis for that; for instance, a religion might not permit blood transfusions. No matter how dire the consequences if the patient does not allow for blood transfusions then we must refuse. Patient choice and autonomy.

A patient's religion goes beyond the medical because sometimes it is through religion that these patients find relief. An 18 y/o pediatric patient goes blind suddenly. In his history, he mentions that it is through his religion that he found hope. Prior to his blindness he was an athletic person so imagine how he initially felt and remember he's an adolescent. Remembering psychological developmental stages, it is around this time that a human being strives to be independent.

A mother of 33 y/o patient with recurrent urinary tract infections (UTI) is stressed with her son's condition because urine culture has shown that the strain responsible for the infection is resistant to the first-line antibiotics necessitating more expensive medicines. The patient himself finds relief in serving in church activities.

There are many more stories of such patients. Who am I to strip these patients of hope? So as to avoid challenging these patients, I create a space within myself. In those moments, I become a doctor, nothing more and nothing less. Their stories pass through me.

In conclusion, I'm not going to deny that religion gives some people hope. I'm not superior nor inferior to religious people just because I don't rely on religion for hope. It's just that I have other sources of hope. Anyhow, let no one use the recent tragedy for any end whatsoever. At the end of the day, we're all human beings capable of empathy and feeling. Let us not ever forget that, ever.

Future Writing Directions

Although I'm loathed to put a direction to what I'm going to write, it somehow helps if I have a guide. And I have ideas for essays really; I just haven't put my mind into putting them down in words. So here are some tidbits of what I plan to write (so I actually put them down in words instead of being in a month-long hiatus). And it ties me down to this blog so again I won't be in a month-long hiatus.

1. Exercising and Medical School, is it possible?

2. Health in the Philippine Setting (argh, a bit general and requires so much research and that's partly the reason why I'm loathed to write it but I want to. So if anyone can put some inputs in the comments or email me at torres.ryan550@gmail.com; it may help me.

So far, I'm thinking how the closed economy, centralized and Presidential system of the Philippines is directly responsible how a) patients have to pay out of pocket for the medical expenses, b)all the doctors, general practitioners and specialists are concentrated in Imperial Manila, with exceptions of Cebu and Davao and c) how our Secretary of Health have to beg Congress for their budget because of the separation of powers, Executive and Legislative. Hence, instead of cooperation, the department secretaries have to 1) compete against each other and 2) compete against Congress, remember department secretaries are appointed by the President and the Congress is elected by the people.

See, ambitious essay so inputs are really welcome.)

3. Journey through Medical School So Far (I promise none of that cliched "Oh medical school is so hard". I'll think of an alternative angle. For instance, it can be fun)

4. Unbelief So Far (if I think of any)

5. If I feel anything (Okay, here's my writing process. I actually have to feel something before I write anything actually. So I feel nothing there is nothing to write about). 

Anyway, let's see if I can do all of this in the list. And again, I put it in list form so I have a clear direction and it's sort of a commitment.  

The Ethics of Death and Dying

(Sidenote: This is the final essay for the requirements in our Medical Ethics class. I've somehow missed the way Ethics was taught to me during my undergraduate years. Yes, I'd had to read through Kant, Confucius, Foucault and Aristotle. Well, a little of each; I didn't exactly finish all of the required readings for the course but I got the main gist of their ideas. And indirectly, being forced to read so many readings that have no connection whatsoever to my course did benefit me during Medicine. At least now, I can honestly say, although the readings are long at least they're straight to the point. Unlike those philosophers, with Ricoeur as an exception

Anyway, what are your thoughts about Death, Life and Dying? Please leave a comment and again, I apologize if I'm not able to reply instantaneously. Oh, this was written in reaction to the film, "Wit", more specifically the scene where Dr. Vivian Bearing was given the option of being resuscitated or not by the nurse.)

There is always something unknown about death. However, this is in direct contradiction to health professionals who require certainty. A health professional performs a very detailed history and a thorough physical examination. And then orders all sorts of diagnostic imaging to arrive at a certain diagnosis. All of this certainty is built on avoiding the greatest uncertainty of them all: death.

            What happens after we die? Nobody knows and no one can really say for sure. Some say there is an afterlife, some say there isn't  One thing is for sure, a human person ceases to be when he dies and this is what is at the root of death. A human being cease. No one can really say if he went to heaven or became one with the Force or any other primordial energy. What is left is the pain of loss among the dead person’s loved ones and those who knew the person during his life.

            No one can really explain death. Sure, we health professionals can explain the pathophysiology of a patient’s cancer and we can explain how the glutamate cascade is responsible for the death of neurons in a stroke patient but we really can’t say why that particular person. No amount of explanation can wash away a person’s cessation of existence so it is but natural we stave away death. We invent all sorts of contraptions and interventions to avoid death and prolong life just so we can avoid the biggest uncertainty of all.

            Yet there are times when patients opt for a DNR, Do Not Resuscitate. For a physician it may seem like a slap in the cheek. Here you are trying to save this patient’s life yet this patient has given up hope and prepares for the inevitable. Is the DNR patient less than human for giving up? And conversely, is it always the default position to fight for life at all costs? 

            The resounding answer is a big no. A DNR can be seen as an acceptance rather than giving up. Sometimes life at all costs can be too high a price. Can we say that a person is truly alive if he or she is hooked to a machine? Far from being seen as a sign of weakness, a DNR simply means another option. It is but another choice for which nobody can be condemned for. Just as long as the circumstances were made clear to the patient and he’s been given all the time.

            How we treat the dying says about how we think of Death in general. Treating them with scorn and prolonging Life at all costs shows how we secretly fear death. Does a person cease to be a human being if he accepts he’s going to die? Of course not for Death is but a part of being human. There can be no Life if there is no Death.

            Far from thinking Death as a big uncertainty, it can be thought of as another journey that all of us have to take. We can try to delay it as much as possible by living a healthy lifestyle or by heroic measures but inevitably we die. On a personal level, we can never be sure of what is going to happen but for those left behind, we leave a legacy. So really, a DNR is but another option. What is more pathetic are people who can’t come to terms with the inevitable and prolong life at all costs.

            There are a lot more things worse than dying. What we can do is treat Death with humanity instead of fear and scorn. 

Revelation

(Side note: This essay was written in response to a lecturer asking all of us why we chose to be in medical school. I have written about it in great detail here:  http://thelukanmd.blogspot.com/2012/11/start-of-lukan-medical-journey.html. As I was writing this particular essay, I focused on the particular event that started it all. And as the title suggests, it really did come to me like a revelation, a sudden jolt or realization. It's somehow of a refresher essay for me of why. I've changed since I've written the very detailed reason but somehow the reason is still there although somewhat modified.)

            It starts with a crazy idea as these things go. As I was nearing the end of my college stay; I absolutely had no idea what I was going to do after I graduate. Initially, I started like those traditional medical students who right after high school wanted to go to Medicine. I even chose the quintessential pre-medical course. And yes, these decisions solely came from me; my parents never forced me into anything. The only thing they chose was what university I’d be entering. However, when I entered into college; I never imagined it would be that hard. I breezed through high school getting high grades without breaking a sweat.

It got me thinking that if I went to Medicine; it would be harder and there would be a lot more reading to be done. I didn't exert much effort back then. And before I knew it, I was graduating and with no clear direction. So yes, I was an underachiever back then. I didn't study throughout the night. And I even slept early.

            I remember it was a morning during my free time. I was sitting at a computer terminal in Rizal Library. I suddenly had a revelation that I didn't like animals or plants or even microbes. What I really liked was studying humans. I've been denying to myself that I was born to be studying and learning. So without any prior notice to my parents; on that same morning I registered myself to take the NMAT and enrolled myself in review classes. All that was left to do was choose what medical schools to apply to.

            As I was late in planning for medical school; I didn't know the choices. I couldn't apply to the medical school of the university because I lacked units so I had to search for other options. So I searched through the Facebook profiles of my batch mates and through that search I made 3 choices. Initially it was only 2 but I added a 3^rd option because of my unspectacular undergraduate GWA. And to cut the story short, I was accepted to only 2.

            So far, I can say I made the right choice. Although, sometimes it depresses me because I’m 24 yet I’m still in school and still dependent on my parents. However, it brings me unspeakable joy when I get asked by people about medical knowledge. Heck, every parental visit sometimes becomes a medical consultation. And I haven’t even obtained the mystical “M.D.” added to my surname. It comes with a pressure to be updated but I've learned it only drives me to learn and read further.   

The Ethics of the Patient-Doctor Confidentiality

(Side note: This essay was written in reaction to this: http://www.youtube.com/watch?v=MoP7xgW1A9U. To summarize, the doctor in question posted on Facebook some sensitive patient details. The doctor didn't post the patient's name. However some people want the doctor to be fired because she violated patient confidentiality. How about you, what are your thoughts about patient confidentiality? Please leave a comment below )

            At Mercy Hospital, there was an obstretrician/gynecologist who upon posting on her Facebook wall patient details; she was fired. She was merely venting her frustrations because said patient was late for her appointments. She did not post said patient’s name or photo and only included some medical data that is not specific for any patient. Her post ended with “May I show up late for her delivery?”

            In the USA, there is no law prescribing the exact specifications of the patient-doctor relationship. Instead it was based on the Hippocratic Oath with this passage: "Whatever, in connection with my professional service, or not in connection with it, I see or hear, in the life of men, which ought not to be spoken of abroad, I will not divulge, as reckoning that all such should be kept secret." And information divulged by the patient can only be said to fellow medical professionals as evidenced from this passage, again from the Hippocratic Oath: "Those things which are sacred, are to be imparted only to sacred persons; and it is not lawful to impart them to the profane until they have been initiated into the mysteries of the science."²

            And instead, doctor-patient confidentiality is centered on ethics and there has to be a doctor-patient relationship to warrant secrecy for effective healthcare. Laws only specify up to what extent such information can be made available. Such cases include notifiable diseases and medical databases although patient identifiers are not included. Finally, only the patient can void the doctor-patient relationship and in medico-jurisprudence cases where medical information is necessary.²

            First and foremost, there was no patient-identifier present in the doctor’s Facebook post. The patient’s photo was not even present on the doctor’s wall making it difficult to say that the doctor was pertaining to a specific patient. The obstetrician/gynecologist was merely expressing her right to free speech and venting because of her time wasted due to the patient’s lateness. It can be argued that her post was demeaning to the patient but only up to a certain extent. It can be likened to an employee in a company venting about her customers but we seldom hear complaints about these people. However, it seems that the doctor is subject to higher standards than most employees.

            The doctor-patient relationship is a relationship that is based on trust. This means that the patient can trust the doctor to always do what is in his/her own best interest. The doctor is tasked to always be professional towards patients and is trusted that he/she will prescribe the necessary medical interventions. This element of trust is crucial because without it; healthcare cannot be effective. ¹

            What people are reacting in this doctor’s case would be the issue of trust. Even though there were no patient-identifiers present in the Facebook wall; they feel that the trust people put in doctors has been violated because details that can only be obtained from a real-live patient has been announced in public. There is an implied understanding that parts of the medical interview is confidential; there are exceptions but even then, these are rare.          

            And when doctors reveal intimate details, it was as if the doctor was undressing a patient in public and exposing the patient’s body. It is this act of nakedness that is inherent in the doctor’s seemingly harmless Facebook post. The doctor may not have posted the name or photo but she has still exposed part of the patient to the public.

            Which brings us to the final point: should the doctor have been fired for exercising her right to free speech? And the resounding answer is no. Instead she should have been given a reprimand. Medical professionals are subject to a higher standard because there is an element of trust in order to deliver effective health care. The difficulty lies in determining where does this trust end and where does it begin. With the advent of new technologies such as social media; information is easily spread. For instance, post an embarrassing photo and it will spread like wildfire.  

            As such, all medical professionals must always be cautious in posting details about patients even if they are unremarkable and innocent. It also helps if the tone is in a neutral manner. It is not that medical professionals are to be silent but they should be highly aware that whatever they say is subject to higher scrutiny because they deal directly with people’s lives and can affect them. Whether we like it or not, we will always be under intense scrutiny and as such we will have to deal with job pressures in a professional manner.

References:

1. “The Doctor–Patient Relationship Challenges, Opportunities, and Strategies”. Susan Dorr Goold,  Mack Lipkin, Jr. 25. Jul, 2013. J Gen Intern Med: 1999 January; 14 (Suppl 1): S26-S33.

2. "Healthcare - Doctor-Patient Confidentiality." Encyclopedia of Everyday Law. Ed. Shirelle Phelps. Gale Cengage, 2003. eNotes.com. 25 Jul, 2013. <http://www.enotes. com/healthcare-reference/>. 

Integrity

(Side note: This essay was written in response to a lecture about integrity. The funny thing was, I had to cut that class because I wasn't feeling that well so I had to rely on 2nd hand accounts of the lecture so that I know what the lecturer was talking about. Anyway, what I've written is not just for the sake of passing the class but it comes from the heart. Who knows, maybe someday I'll come back to this post if ever I feel like giving up or taking shortcuts detrimental to a patient's health and life.) 

            Integrity is something that is important in all aspects of life. It is not the sole monopoly of medical doctors yet due to the high expectations placed upon medical doctors; it is highly stressed upon us. For instance, a doctor without integrity will easily prescribe drugs just because the drug company gave him a huge financial incentive without even thinking of the possible side effects that the patient can experience due to the drug. Worse, it might not even be indicated for the patient’s condition.

               However, integrity is not something that is easily passed on or easily taught. It is not something that can be learned through a class. It is something experienced and observed. Also, it is something that is imbibed meaning that a person must choose to embody integrity. And in choosing to do so, that person must have a very deep reason for embodying an abstract yet important idea.

                Practically, a medical doctor with integrity will be visited by more patients because he can be trusted to give cost-effective medical interventions without being swayed by the pharmaceutical companies. On a much deeper level, said medical doctor can sleep better at night because he did not place any human being in harm’s way. Either way, a medical doctor with integrity is a full-fledged medical doctor.

                But then what does it mean to embody integrity? The most important thing is that this is an ongoing question that the medical doctor must answer everyday of his life. This question is re-asked and re-answered whenever new situations arise to combat the medical doctor’s values or outlooks on medical practice. That is not to say that integrity is limited to the medical practice. It is not. The question of integrity permeates even outside of the medical doctor’s practice. It permeates the life and relations of the medical doctor. Even the simple act of being on time for every appointment, however small a gesture, is already an act of integrity. And yet integrity is a question. It is something that is redefined and cannot be sequestered into a well-defined box.

                Finally, integrity can be likened to an ongoing re-evaluation in the sense that it requires re-updating of one’s outlook and values. To put it more concretely, what may seem an act of integrity then can be an act without integrity today. No act can really be defined as full of integrity for definitions will invariably exclude the person who will execute said act. One can only be guided by his own values and other human being’s own values. It is important that a medical doctor always strives to better himself. In the fullest sense of this phrase: a medical doctor is not just a medical doctor. 

Apologies (or Excuses)

I apologize to my regular readers (if I have any) for the lack of blog posts these months. 2nd year Medicine in the Philippine setting is a bit more challenging. Many more subjects hence more books to read. Thick and heavy books.

Anyway, I'll be posting a few essays I've written for my Medical Ethics class. Not just because they got high grades but well, someone might benefit from them.

Finally, to describe 2nd year Medicine in a few words: exhausting, endless readings but fun. Here is where what I learned in 1st year (Human Anatomy, Human Physiology, Medical Biochemistry, Foundations of Medicine and Preventive and Community Medicine) blends into these subjects: Pathology, Microbiology and Parasitology, Pharmacology, Clinical Evaluation, Medicine I, Neurology I, Preventive and Community Medicine II, Medical Ethics, Pediatrics I, Basic Science Research. 2nd year is where diseases, drugs and how to conduct a physical examination and medical history are taught.

How Medical Missions Actually Make People Poorer

You're all familiar with this: health professionals wanting to help their fellow countrymen/women. And since they are trained for giving services to others, what better way to help then to give a free medical check-up and free drugs a.k.a. a medical mission. I am not against people helping other people out that is a very noble gesture. However, we have to look at the unintended consequences and the long-term effects of these missions.

Sure, you may have helped people by giving free diagnoses and free medicines. But without looking at the systemic cause of their ailments; the people you've treated will just get the same disease. Also, with the current set-up of medical missions, you've removed their agency and made them into mendicants dependent on health professionals for good health. 

Any medical mission will thus have to be based on this premise: would you give people fish or teach people to fish?

In any case, my specific recommendations would be the following:

1. Remove food supplements from the roster of drugs you'll be giving to people. You're really not helping them. In the medical mission I participated in, the people almost always requested for food supplements for themselves and their own children thinking it was the norm. Sure, you may keep people in good nutrition for a short period of time but that doesn't attack the root cause of their malnutrition in the first place which is poor eating habits.

Think about it, where do you get vitamins and minerals from nutritious food like fruits and vegetables right? So people should eat more of fruits and vegetables rather than junk foods. Of course, the usual counter of the people being helped would be a) because their children doesn't want to eat fruits and vegetables and b)the parents are busy working so they cannot guide their children into eating proper food. Impress upon them that is it their own responsibility to maintain their own health and of their children. It is their job to teach their children and caretakers proper eating habits not the responsibility of health professionals.

2. Only take drugs for diseases present in the community you intend to help. This I admit entails a lot of homework because before the medical mission proper some people will have to go into the community and ask around. This saves time and effort. Why would you stock up on drugs that have no recipients in the first place? And this is connected to point 1. It also removes the temptation of people stocking up on unnecessary drugs. Remember that all drugs have side-effects and should not be taken unless directed by a medical doctor.

3. Eliminate "tuli" missions for they are really not that medically necessary. Honestly, there are minimal benefits to be gained by circumcision. Sure, it decreases the chance of acquiring sexually-transmitted diseases; however, the better approach would be to educate the people on sexuality and how to prevent transmissions of STDs. You may ask why I include sexuality. Well, any talk on STD prevention will always need a talk on human sexuality. People will have to be aware that their own sexuality is something beautiful not abominable. Also, educating males about proper cleaning of their penises is much better than mandatory circumcision. Anyhow, I digress.

There is a strong stigma against uncircumcised men in the Philippines but ask yourself, are you health professional or a "datu"? You are there to help with medical emergencies and cultural passages of manhood need not concern you. Does it really make sense that a 10 - 12 y/o boy is forced to undergo mutilation of his foreskin just for the sake of being called a "man"? The better option is to let the boy decide for himself.

And to make this point inclusive of all medical missions: only prepare for medical interventions that are necessary to improve overall health. So giving antibiotics after being examined by a medical doctor, dental work and referring to the nearest hospital is okay. These sorts of interventions.

4. Frame your medical missions in the preventive aspect not on the curative aspect. Curing diseases is good however it makes better sense to prevent these diseases. Take for instance pulmonary tuberculosis and hypertension. These were the common diseases I encountered and in fact common diseases found amongst Filipinos. The Department of Health already has its TB-DOTS program in order to provide early detection and treatment of tuberculosis. Inform the community that tuberculosis is not something to be scared off and there is the TB-DOTS program. I am aware that it is not that simple; however, we have to start from somewhere.

And hypertension is really connected to point 1. If you really think about it, poor eating habits contribute to the high incidence of hypertension found amongst the poor. The cheapest foodstuffs are those with a high salt concentration. So if you don't correct their poor eating habits; you've really not helped them at all. Remember that maintenance drugs of hypertension are expensive and have to be taken everyday.

So in the long-run the economic costs will outweigh whatever curative intervention you hope to accomplish with the current model of medical missions. Not to mention the unnecessary loss of human life.

The list is not exhaustive. There maybe some other aspects that can be improved; however, always remember that it is the people's responsibility to good health not the health professionals.

Now, I anticipate that these recommendations would be met by hostile resistance amongst other health professionals and the people you intend to help. Filipinos are great enablers after all. But it is precisely this behavior of Filipinos that these changes must be implemented. And I also anticipate that the number of people who will attend your medical missions after these changes have been implemented will drastically decrease.

However, at the end of the day; it is their responsibility to maintain their health. But to be realistic, introduce these changes by "breaking it to them gently". For instance, inform the community leader that there will be changes to your medical missions and your intentions behind the changes.

Change is always hard and it's easier to keep to the status quo but really, the status quo just produces mendicants.

A Dichotomy

It's one of those things that you don't intend to do but you are forced out of familial pressure. Me, visiting a shrine in Manaoag, Pangasinan. I've been here before but this time it's different. I no longer belief in anything supernatural for it is an insult to the scientific training I've received and the medical training I'm currently undergoing. Well, I just sucked up my disgust and walked around. It has improved. Before there was no canteen, the rest rooms sucked and the big statue of the Virgin Mary was hidden away. Currently, it's now at the center of a grandiose structure with candles placed around it. I can imagine at night the big statue being illuminated by candlelight.

How I hated it.

Contrast that with the Philippine General Hospital. I can honestly say it has not improved. You have diagnostic laboratories just across PGH and you have the Faculty Medical Arts Building just inside the premises of PGH. For those unaware, FMAB is a private hospital. Anyway, what do these two points imply? Simple, the Philippine General Hospital currently sucks. Well, to put it more substantially: a) why would you have private diagnostic laboratories across a hospital that is mandated to provide the health needs of the the common public and finally, b) why would you have a private hospital, FMAB, inside a public hospital, PGH?

And I hesitate in going to the provincial hospital in Pangasinan. It might even be in worse condition than the Philippine General Hospital.

But somehow, I'm not surprised at this strange dichotomy. The religious when sick ascribe their healing to the intervention of a supernatural deity despite the clear evidence that it was the medical intervention that saved them. And let's not forget the placebo effect.

It is time to move forward. I am not saying that all Filipinos should be atheists/agnostics although it would warm my heart if we were to become a purely atheistic country. Rather, it is time to prioritize rational actions over divine interventions. Gods will not save us from our wretched conditions. Humans are the ones responsible for these conditions and it will be humans who will solve them.

When we were done with the visit; I noticed something else. There were fewer people. I mean during the 1990s, the time when we visited the shrine, there were lines just to get inside the basilica. And the area where you put candles was crowded. Of course, I can't conclusively say the number of visitors to Manaoag decreased. But you can't help but wonder.

This Time...Something Political

So haven't blogged for awhile; blame the vacation. I have absolutely nothing to rant against...maybe except for those missionaries preaching in buses. Now, I'm well aware that they have the right to freely express themselves but it is so tempting to make their activities illegal. What about my right to freely enjoy the bus journey itself? But enough of that. It's April 2013 with the May 2013 elections looming and guess what; I'm not voting.

Let's see, between you and me; it is such a waste of time and effort. Now, now...before you dismiss this as a rant born out of laziness, lack of civil duty and disgust for my country; in fact, I love my country but I'm not blind to its defects. Kind of how I love my college alma mater. I respect how it molded me and how I currently view the world but it doesn't mean I am not blind as to how some of its graduates are flawed and that's putting it lightly.

Ever notice that most Senators, Congressmen and Presidents, with President Aquino as the very epitome, are idiots. Worse, they win solely on name-recall. In fact, if Corazon Aquino didn't die just before the May 2010 elections; her son wouldn't have won the presidency. Even if some Filipino with some brains campaign; they have little chances of winning. Our current system favors the popular so it is no wonder why Filipino politicians are a)idiots, b)celebrities and/or c)have famous last names. So potential voters like myself who are not easily bought into popularity and have a tendency to scrutinize everything are diminished against the majority of the Filipino populace who tend to view things in a more simplistic manner.

Not saying that the Filipino masses are idiots because that will tend to put the blame entirely on their shoulders. They are partly responsible yes, but the current system is the bigger culprit. Notice how the senatorial candidates campaign as individuals whereas in other countries; politicians campaign as parties with solid platforms, policies and programs. And who can help not notice that our parties are just instruments to power with candidates shifting to the favorable party. In short, when politicians are voted into power; they are voted as individuals with no regard for cooperation.

Our entire system is flawed. There is no escaping this stark reality. You will have some Filipinos proclaim loudly onto cyberspace that "THERE IS NOTHING WRONG WITH THE PHILIPPINES!" but the bitter reality is there is something utterly and devastatingly wrong with the present country. And the sooner one realizes this; the sooner the Philippines can become better.

Let's take poverty: it has remained unchanged since 2006. And this despite the Aquino administration's massive spending on its CCT, conditional cash transfer, programs. Gee, when you tend to provide dole-outs (let us not kid ourselves, no matter how many word-plays the Aquino administration provides; it is in essence a DOLE-OUT), it makes people dependent on other people to succeed. In other words, you are just promoting a culture of free-loading and mendicancy.

So do we take to the countryside and wage open war on the current government? Let's see, an armed group has been doing that for so long: do you really want to give your lives for an outdated ideology that has already been proven inapplicable in reality? 

I propose these solutions:

Let us start at the personal level. The sooner you realize that no one can save your self except for your self; the better. Take for instance alms-giving. I used to give money to those who were asking but thanks to encountering a very self-entitled man along the avenue of E. Rodriguez I've longed discontinued the practice.

Seriously, I mean imagine me walking alongside E. Rodriguez when I get accosted by this man, along with his family and child, asking me for money because he forgot to bring enough to commute back home. So I asked him all sorts of questions but for some reason I felt he was a scam artist; by an act of coincidence, I also encountered a scam artist along E. Rodriguez. In the end, I didn't give him money. And he had the nerve to get all high and mighty with me! Imagine, the very nerve! I was seething inside because first of all, not my fucking fault you forgot to budget enough money to commute back home and second of all, you should be ashamed that a grown man like you is begging for money from a complete stranger in front of your child. I just stared at him, not wanting to make this father seem more impotent in front of his child; I'm not that cruel.

It may seem a sadistic philosophy but what would you prefer, babying other adults? It is this sense of mendicancy that pervades the Philippines and you wonder why we don't progress. And by extension, how some politicos get into office. And how the Catholic Church got its stranglehold over the populace in the first place.

And the more far-reaching solution: support Constitutional Reform. See, those idiotic politicos are given the chance to assume political power because our 1987 Constitution is especially designed that those with popularity win. And by extension, why jobs are so scarce here. The very ultimate example: our UPCM, University of the Philippines College of Medicine, doctors are working as doctors...IN THE USA! Oh, don't get mad at them; get mad at the 1987 Constitution with all those economic restrictions.

Until that wretched 1987 Constitution is corrected don't expect our politics to progress beyond popularity and name-recall. Don't even get shocked if Nancy Binay manages to become a Senator because that's how our Constitution is designed.

Until that time, don't expect me to vote.

A Priori Assumptions

These are assumptions that already have it's conclusion beforehand. The very common example of this is " Absence of evidence is not evidence of absence. If you are an atheist, why you do affirm that God does not exist?". I encountered this early on in my life in high school when a professor uttered this formulation: "you cannot deny something which does not exist". So, at first glance; seems my unbelief is unjustified and in fact, I held on to this formulation as basis for believing in a god.

However, this is a very good example of a priori assumptions meaning that the existence of a god is already assumed when it should be the other way around: assume first a neutral stance, a god does or does not exist. Then, you go about proving your deity's existence.

Let's use this analogy:

Suppose you want to discover a cure for cancer. You don't start with the assumption that there exists a cure for cancer. You start by assuming there doesn't exist a cure then you search for answers that will lead you to said cure. Imagine the laughter you'd get if you were to defend your research protocol with the a priori assumption that you already have a cure for cancer. 
 
I post about this because I encountered this argument in the Filipino Freethinkers Facebook page. A theist, a Theology student, posted it and I had the pleasure of refuting his biological justification, he used the existence of the genetic code to argue for the existence of an intelligent god; so I had cause to jump in. And I was a bit disappointed with the refutation he gave me: original sin caused those genetic imperfections meaning because Adam and Eve did it and by extension the bible is literal. So imagine hard science facts, I used the existence of introns and exons, genetic diseases and reverse transcriptase to argue against an intelligent god, while he used Adam and Eve. Can you imagine if he was to defend a scientific thesis? 

Anyway, I mention that incident because such people, theists, always cheat on their arguments. They always assume beforehand that their god exists and instead of resorting to hard facts like Science they always use long philosophical ramblings or their holy book. 

So if someone wants to prove a god's existence, it's very simple: provide evidence. However, I will tell you that these things DO NOT count as evidence:
1. the bible (do you really want to go there? With your god condoning slavery, genocides, rape, misogyny and torture)
2. subjective experiences like miracles and apparitions (I mean it should be something objective meaning I, personally, can go out and check it INDEPENDENT of you. Heck, use this as evidence and I'll think there's something wrong with your pre-frontal cortex.)

And please, do not even think of shifting the burden of proof on me. The one who proposes the claim (God exists) must be the one who proves it. 

A Conversation While Walking Near Trinity

Lunch time with Mary John was over and as we were walking near Trinity University; a bell struck and some ritual prayer was being broadcasted in the university speakers. If I had been alone; I'd have walked on because I don't belief in such rituals but out of respect of my friend I had to stop and pretend obeisance. Funny thing is, he's not Catholic (from his explanation, he belongs to another denomination of Christianity so essentially not a Roman Catholic like me. But unlike me, he's still a theist). He stopped out of respect of their beliefs.

Well, he knows of my unbelief and he respects them. While I also respect his need for religion. The only comment I make is that I hope he doesn't trade his glorious La Sallian brains and blindly follow someone just because said someone claims he/she hears God speaking through him/her. Anyway, we had a very animated discussion about respect. That while my views are valid; I should also give Roman Catholics respect. However, I disagreed a bit because what does this "respect" mean.

Notice how I'm  forced to go along with Catholic religious rituals just because it is the majority's religion. Just because it is the majority position; I have to go along with it because I belong to the minority? I mean I wanted to walk out of a lecture by the Physiology Sensei last December (it wasn't Medicine-related and it was the partly the subject of this entry). He basically invited a religious alumna to share her experiences and emphasizing that belief in the Judeo-Christian god is necessary for one to have values and to survive medical school.

They also emphasized that values come from the bible and it is integral to being good physicians. Part of me wanted to question this; apparently the bible can be the source of all values...well disregarding the genocides. Alas, did not. Well what would you have done had your Physiology professor been lecturing? Would you have risked being given a failing grade?

And this happened when I was questioned by a fellow classmate about my newly-found unbelief. I'm a bit wary answering these types of questions from theists because I know I'd be met with disdain. Oh, I met disdain all-right. Well, not from the questioner, he was genuinely curious, but from his friend. I've made my dislike for her clear but apparently my unbelief cannot be respected. She was acting bored and I was getting the feeling from her that she really didn't want to listen. See, I could tolerate her dislike (she isn't completely faultless by the way; anyway I don't begrudge her dislike of me. I'm not in medical school to be liked by everyone). But I couldn't tolerate sloppy manners and thinking. I mean had I wanted to inquire about their theism; I would have listened whole-heartedly and if I had questions I would have asked them with respect. I mean had she, the one I disliked, been the one speaking about her views I would have listened, at the very least I would have faked listening. But apparently, I belong to the minority so I am easily dismissed.

To be fair, we were all tired from waiting for a long experimental procedure so maybe that wasn't a time for a proper philosophical discourse. Still, really couldn't tolerate sloppy thinking (her manners are somewhat excused but her disdain and lack of respect isn't).

Also, where is "respect" when I can't question their beliefs? How can I turn a blind eye to these items: a woman dies needlessly in an Irish hospital because the fetus still has a fetal heartbeat; never mind if the baby is already dead, our increased HIV cases is partly caused in part by the blind obedience of GMA to the Church's demand that condoms should not be distributed, the cover-up of many child molestation cases (there are many so I'll just cite one) and so much more. See, how can I stomach these many wrongs done by the Church? Also add the pope's erroneous statement that condoms cannot prevent HIV/AIDS. See, as a physician-to-be; I cannot stand by and let these erroneous medical judgements be perpetrated by these so-called "holy men". So imagine how many people has the Church killed or molested either directly and indirectly?

So excuse me for escaping my veneer of apathy but I couldn't stomach these inconsistencies and wrongs. And "respect" doesn't mean I can't question your views; in fact, it means we can question each other. It doesn't mean I have to agree with your views (or you with mine). We can leave the discussion, I refuse to call it a debate because a debate implies a winner and a loser, with disagreements. These disagreements actually strengthen us. Respect means that all views are given equal air time and not just because it belongs to the majority position.

To end this entry; I think the reason why theists have this false idea of respect is due to what is called "The God of Personal Necessity". I provide a part verbatim:

"Of course, it's also one of the hardest fallacies to explain to a believer because so much of their persona is invested in this delusion. That their god fills their personal requirements so perfectly and completely is often the reason they subscribe to the 'faith' in the first place.  To consider for one moment that their god might not conform to their requirements is to attack their entire reason to be deluded in the first place." Taken from here.

Just because I question your belief does not mean I am attacking you personally; it just means I couldn't stomach the wrong being done by your fellow believers and your religious leaders.

Values from the Big Three

What school are you from?

Red flag alert! You see, when someone asks me that, especially someone who I meet on a dating site; I have a sinking feeling in the deepest pit of my stomach. That only means one thing; there is a high chance that said person is either a La Sallian or Atenean.

But, we are getting ahead of ourselves. The night began as any other night; me, reading my favorite medical school book, Guyton, after exercising. In my favorite haunt, a 24/7 Burger King; really can't study in my room because of the temptation of the bed. Exams were nearing; hence, the necessity for re-re-reading. But I am only mortal and require breaks here and there. And with the presence of the Internet; it's easier to meet random strangers.Then that person send me a message and I sent my contact details. As we were conversing; that infamous question came up.

You see, for me; I really do not care what school you graduate from as long as what you say and do is not idiotic. And if you wave that Isko, Atenean or La Sallian diploma then be prepared to meet my high expectations. And my suspicions were correct; I was speaking to a La Sallian. A fellow brethren; no matter how you spin it Ateneans and La Sallians resemble each other. Both schools have high tuition fees and are run by liberal religious orders. See, I have this rule for not considering my fellow brethren because they have this tendency to be so full of themselves. This tendency is even increased if the course has something to do with the corporate world. But being me; really lenient so decided to give it a shot.

 To cut this entry short; it was literally and metaphorically a date from hell. An incarnation of the very essence of the infernal pits if it ever exists. If it doesn't then this experience can serve as basis for said place.

Some snippets of conversation:

"You know, my father bought this condo unit for me" (Notice the false pride; since when has it been bragging rights if someone else bought a very luxurious condo unit for you. So no dignity for the labor of your own hands then?)

"So where is the Ateneo High School Building located?" (Really now, paranoid much?)

"Why are you staring so far off; is the condo unit small?" (It wasn't because I was controlling my anger)

"Eww, you're not that hot; you know, you are okay to look at but I think you should focus on bulking up"  (As if my body is any of your business!)

"Are you really a medical student? Come on; show me your ID!" (At this point, I was waiting for the moment that coitus would happen. I was hoping my rage would disappear with the post-coital bliss)

Alas; it did not. I initially said I would spend the night but I couldn't stomach the pomposity and the arrogance. So I stormed out of that condo unit; never mind that I looked like the asshole. If anything good came out of that experience is that I was given the necessary fury to first-read 3.5 Physiology transes at 12 midnight.

During that date; I was really dumbfounded. Where were the values of La Salle? I mean for Ateneans; we are taught "magis" (literally means "more"). So you are expected to be very good at anything and to give it your best shot. Also we are taught to be "cura personalis" ("persons for others"). For La Sallians; I have no idea but I know they are taught values along with excellent education. I mean I have La Sallian friends that I look up to; heck, two of my medical school friends are La Sallians.

I was literally comparing that date with my two La Sallian friends. Let's call them "Mary John" and "Don". Mary John and Don aren't the typical La Sallians; not conyos or anything that would suggest they come from that respectable school in Taft. They are so laid-back and down to earth that I instantly warmed up to both of them (well, I'm closer to Mary John because I had this tendency to use his Iphone during classes and now, his personal wi-fi hot-spot but I digress). See, Mary John is the very quiet type but I wasn't fooled. Day one from spotting him; I knew he was someone to watch for and true enough, behind his quiet and thin demeanor lay the seeds of excellence.

He's the very epitome of what a La Sallian should be; smart yet caring as he demonstrated to me when I, uhm, fucked up. Partied BEFORE an exam and I paid for it for getting exam grades lower than my usual standards. So I mourned it and even came to the verge of crying and asking him his personal assessment if I still had what it took to be a kick-ass physician (well, I don't want to be just any garden-variety physician). With his quiet words of encouragement and his humble smile; he still said yes with the follow-up,"Huwag ka na mag-party before ng exam ah".

So really can't be mad at all La Sallians. I have great respect for that venerable school in Taft; not really into the Ateneo-La Salle rivalry. For me, it can lead to disastrous results because the exaggerated version can lead into disunity and distrust. So what are the values taught by the La Sallian education? If at the end of your La Sallian or Atenean education you end up being like that date from hell; then I feel sorry for you. So don't blame me if I tend to gravitate towards Iskos.

Well, not that all Iskos are down-to-earth but the chances of meeting persons who are full of themselves are markedly increased if said person comes from either that school from Katipunan or Taft and if their courses have something to do with business.

Then again maybe I really have the shittiest luck.

The Glory of the Vagina

The following exchange happened during the last-minute studying for Physiology (Urinary and Reproductive Physiology). Well, not exactly verbatim.

Me: (Speaking to a girl friend). You know, your vagina is a very beautiful organ

Girl Classmate: It's getting a bit creepy discussing that.

Me: What?! (Got surprised at this point because I was like practically praising their genitalia and yet, here she was acting all bothered and disturbed. I mean I would have totally understood had I been making disparaging remarks about their genitalia but I wasn't. I was like pouring praise upon praise about menstruation, ovulation and pregnancy. Seriously, it is a very beautiful topic. I can only appreciate what women go through intellectually; I don't have a vagina. Hmmm...imagine if I'd been born a woman; I'd be praising penises but I digress)

Me: There's nothing wrong with it; your reproductive cycle is a very beautiful process.

Clearly, there is something wrong when a biological male can freely discuss a woman's vagina while a biological female cannot. Not that I'm reducing women to their vaginas; I mean gender is a very complicated topic. Gender is something not just reducible to one's genitalia. But since I'm a scientist; I only can discuss something that is concrete. And in this case, the human female vagina.

Here I was, after studying the female reproductive tract intensively, spreading my new-found praise and appreciation for what women go through; only to be met with disdain by a biological female.

Women, there is nothing wrong with discussing your vagina. Don't let anyone else discuss it for you (not even me, even if I am a well-intentioned fellow). Own it; spread your own vagina-lore. I mean I understand about treating your vagina as sacrosanct, I agree it is a very divine organ, but does it have to be coupled with profanity. Why does the mere word "vagina" cause you alarm?

See, the problem I have with this line of thinking is that it fosters ignorance of sexual matters. And if we extend this line of thinking further; it fosters sexism in the bedroom. Look at the recent RH Bill debates when Senators Santiago and Cayetano inserted the line "safe and satisfying sex" only to be met with laughter among 5 male senators. And further compounded by Senator Escudero's assumption that just because penile penetration happened; the woman gets an orgasm which of course, is not the case.

And contrast this with the proliferation of penis vandalism; there were many such drawings in Ateneo. So, discussing a penis is okay while vaginas are profane? See the sexual double-standard. Not discussing about the vagina is a very sure way of avoiding unwanted pregnancies; oh wait...why did I just see a girl-child carrying a baby just days ago? 

Think on this: Of all organs, only the vagina is capable of physically touching all of humanity. Well, excluding medical interventions such as Cesarian sections and test-tube babies; safe to say, the vagina can touch/is touching/will touch some of humanity. As I write this, a new-born baby has been graced by passage through a vagina. See, nothing profane about your genitalia and in fact, a very beautiful and powerful organ.

So please, stop thinking of your vaginas as profane and freely discuss it.