Sunday, May 19, 2013

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.

Thursday, May 2, 2013

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.

Thursday, April 25, 2013

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.


Saturday, February 2, 2013

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. 

Sunday, January 27, 2013

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.

Saturday, January 26, 2013

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.

Sunday, January 20, 2013

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.