My Greek Vacation (Athens)

Onboard Qatar Airways, I left Manila at 0100 for my flight to DOHA, then DOHA to Athens. Athens is the first city in my 2 week vacation.

While recuperating from a very bad bout of Atypical Pneumonia infection just last week, I could not wait to get all my bags packed just to simply - get away from it all. After several hectic weeks, it felt like the world was finally caving in on me. All the stress and pressure from work was pouncing on my flailing immune system.

Qatar Airways has always been an on-time airline. Aside from the fact that I love its flat-bed (and I mean 180 degrees flat) with matching pajamas, slippers, duvet blankets, Molton Brown vanity kit and 5-star cuisine, with over 770 AVOD movies, music and games on your personal 15" touch screen TV and head-sets that had a noise-cancelling property, what else was there to ask for even if the flight would be more than 17 hours?

As in every European trip, it's always good to remember that there's no such thing as filling up entry forms when traveling to Europe. Their visa (which although is multiple entry) is usually only single use.

The temperature is scorching hot in Athens at 36 degrees celsius.

So not everything goes as planned. The taxi drivers are on strike in Athens (which meant that I would need to do a lot of walking if I wanted to go from point A to point B). I wanted to get a prepaid SIM card when I arrived, but lo and behold, most of the stores in Athens close at 3pm because it's a MONDAY!!! I went to one of the bigger stores and the salesgirl told me that in Athens on Monday, most of the retail shops open from 9AM-3PM.

The Grande Bretagne Hotel is one of the most (if not the most) grand hotels with a long history in Athens. It faces the Parliament House where you can virtually see from the hotel lobby the changing of the guards every hour on the hour.

Upon arrival, I checked in my bags and needed to walk to the Kolonaki, which is about 2 1/2 blocks from Syntagma Square, for my lunch. On recommendation of my concierge at the hotel, PRITANLON was a good place to eat. And PRITANLON did not disappoint. The Greek Salad and Seafood Spaghetti was more than two people could finish.

The Grande Bretagne Hotel will be home for the next 3 days.

Dinner was at CIBUS, a quaint restaurant in the National Gardens where you could just literally watch day change into night around 9PM. And you'll know it's night already because the Parthenon on the Acropolis literally lights up!

And while it can be literally dehydrating to sightsee Athens in this heat, I'll try my best to get the best out of my first leg in Athens.

Long goodbyes...

I've loved this song from India Arie entitled Long Goodbye, from the first time I heard it. It's lyrics are simple and its written by someone who has truly loved and lost. It speaks about relationships - both good beginnings and endings...put up the volume of your speakers and feel the music and melodies of one truly great artist.

The good seed

In one of the meetings at the office, we were talking about how some of the employees had diverted tactical funds and cash advances for personal use.

Some were using it to finance personal needs, while others were using the company's money for gambling. When push came to shove, the persons involved could only say - mea culpa. Which led us to the discussion of how some people whom my boss described as "good" were led astray because of "temptation" and eventually became "bad".

I had a different take on this. I told the management members (of which I am a member of) that there was no such thing as good people turning bad. Good people will remain good, in whatever circumstance you place them. I believe in the inherent goodness of the human being. Good people do not take advantage of circumstances. Good people will always think and care about his fellow man. Good people will always be there for you even in your worst days. Good people do not take advantage of what is not rightfully theirs. Those whom we caught malversing funds were "bad" people from the get-go. Their evil desires served as fertile ground for finding the perfect storm to resort to actions with malicious intent. Whatever caught up with them was simply "karma".

I have always been a firm believer that there is something inherently good in every human being. Probably in even the worse kind of people. It's like a relationship. Even if you're married into one or simply in a partnership with a significant other, you get to discover both the good and the bad aspects in your lives. It's actually up to us to find and nurture what is inherently the good seed and hope that the good seeds bear fruit.

There's a biblical passage that talks about good seeds being sown on fertile grounds. And then those that grow along the side of the road. Whatever grows out of the good seeds get entangled at times by thorns and bad plants. It takes a lot of love and caring in order to nurture a beautiful plant.

I've had several relationships and while the majority were bad, there were some good ones that came along the way. Circumstances, however, did not permit some of them to blossom into long lasting ones. No matter how much kindness or goodness you share, some of them apparently just don't fit one another. Either one or both become engulfed in materialism, envy, jealousy, greed, infidelity, mistrust, and temptation - and eventually drift apart.

And there's the rub. At times, it becomes frustrating and tiring to see the good in people. Some may influence us in the right way - like good friends or lovers who will always steer us in the right path, while there are others who simply enjoy seeing misery loving company.

In the journey of our lives, it is important to remember that there is something inherently good in every person. And that our lives are intertwined with other human beings. In helping others and ourselves find the right path to making this a better world can we find true happiness, joy and peace of mind.

"Life is good when you're happy. But the better fact is...life is at its best when other people are happy because of you. Never get tired of doing little things for others...because sometimes, those little things occupy the best part of their hearts."

Inefficient

That's the only word to describe the Philippine government and most government workers in the banana republic. While it may not be pervasive only among government workers, government employees who are paid out of taxes from the people must set a better example of efficiency than those in the private sector.

I was reading a front page article in the Philippine Daily Inquirer today, written by a Filipino who is now working for the London Financial Times as editor and who used to be with the PDI. Perhaps because of the nature of her work, she has articulated excellently her travails with getting an exit pass for all would-be OFWs (overseas foreign workers) at the POEA. Amusing and irritating at times, this was a plain mockery of the governmental bureaucracy and crap that Filipinos will have to contend with in their own motherland.

Inefficiency seems to be a trademark of our government. If there is one thing we are consistent with, it's inefficiency among government workers. They will need to find a reason or rhyme in order to be slowwwww. Really really slow. They will declare that there's a backlog of work (and then they take several coffee breaks or check on their text messages while working) or that the person signing the document isn't around - YET - (perhaps at the nearest Starbucks having machiatto with the pimp from last night) or that the agency's computer system is down or slow (and see them keep rebooting or turning the ancient computer systems on and off so that it can restart)...Yes, a million reasons to justify being inefficient. If you find a government agency that is efficient in this country, you will be mesmerized and possibly think that a miracle had just occurred or that you've been transported to never-never land!

Inefficiency does not come naturally to the lowest employee. The lowest form of animal - the lowly employee who probably is least paid and least minded in the echelon of all the work load - can only be inefficient if the upper management is inefficient. That means the boss is a bozo! The boss will depend on his or her employees to get all the menial work done. And if the boss is a lazy bum who prances into his office if and when he wants to and then skips the office if and when he wants to as well, you've got a bureaucracy that spells inefficiency.

I will not go to the sordid details of how this is exemplified in the government offices in this country. I think all my readers will have stories on their own sad experience. I share this thought with my readers because the president of the Philippines has made anti-corruption has his official battle cry when he was sworn into office.

Corruption is a systemic problem seen in every segment of society - whether it is a private corporation or a government agency. Corruption is deeply entangled in an intricate web that seems difficult to untangle. Corruption is borne out of inefficiency.

Inefficiency drives people to bribe others into expediting things. And the temptation to take what is not rightly theirs is the driver to corruption with inefficiency as its fuel. Once corruption is in place, it is difficult to undo the problem unless the problem of inefficiency is addressed. Addressing the problem of inefficiency therefore, is the first and most formidable step at eradicating corruption.

When it takes the police 1 hour to arrive at a crime scene, even if the crime is committed at a house that is a 5 minute walk from the police station is inefficiency. When it takes a government employee 3 hours to process something that should take 3 minutes because he's taking care of personal business, that is inefficiency. When it takes an ambulance 2 hours to transport a dying patient from the house to the hospital that is only 3 km away because of traffic on the road due to all the Maynilad diggings compounded by potholes on the poor-quality-asphalt-roads-after-the-rain streets of Metro Manila, that is inefficiency. When the "pulis patola" (traffic enforcer) is busy texting on the side street while the whole of Metro Manila is caught in a traffic jam or is busy chasing number coded cars while public utility vehicles load and unload in front of their very eyes in non-loading zones, that is inefficiency (if not downright infuriating).

No amount of drum beating by any president or public official can address the problem of corruption unless the problem of inefficiency is tackled head on.

Only then, can we move forward as a nation and a people - proud of our heritage with heads held up high. Otherwise, we will never see the light at the end of the tunnel if we remain apathetic to the vicious cycle of inefficiency and corruption. God help us!

Conflicts of interest

Almost the same time last year, I had talked at the postgraduate course of the Department of Pediatrics, University of the Philippines-Philippine General Hospital on the continuing saga of the doctor and the pharmaceutical industry.

I had mixed feelings giving the lecture. After all, the audience were doctors. They are all my colleagues and many are my friends. Choosing the right words to say was going to be a challenging task. My talk was eventually published in the Philippine Journal of Pediatrics last year.

The issue of conflicts of interest has touched raw nerves in the medical-pharmaceutical community in the Philippines.

Over a decade ago, the Philippine Daily Inquirer ran an article entitled "The Med Rep is OUT - with the Doctor". The article highlighted the extraneous relationships between the physician and the pharmaceutical industry through the medical representative. With the increasing scandals involving various forms of gift giving of the industry to physicians, many pharmaceutical companies and medical organizations are dissuading physicians from getting entangled in situations that may question their credibility due to conflicts of interests.

The other day, I overheard in a meeting that a bunch of doctors had decided to boycott a pharmaceutical company because the company did not accept their request to go to a convention somewhere in Europe! The doctors arrived at the conclusion that since the company had not supported them to conventions in the last 2 years, the accumulated 2 years was equivalent to a convention in Europe. Now that took a lot of gall, if not KAPAL NG MUKHA on their part and I felt ashamed that there are doctors that stoop this low just to attend a convention.

Let me call a spade a spade. You may want to un-friend me in your Facebook account after reading this blog. It is my final blog for the month and while I have been quiet, I also thought deeply about writing this entry.

First of all, the fact that doctors are wined, dined and given gifts is NOT an obligation by the company. WE DO NOT HAVE RIGHTS or ENTITLEMENTS to what the company gives as dole outs. If we accept these gifts, so be it. If we don't, then so be it as well. No one coerces us to prescribe a drug. It's not like they put a gun in our heads and then threaten to annihilate our families if we don't provide them the number of prescriptions they ask for. If we prescribe a drug in exchange for a gift, it is a form of indirect bribery. As doctors, we are already paid by patients our professional fee. That is payment in itself. Prescribing a treatment for our patient entails due ethical and medical consideration of the whole clinical spectrum or condition of the patient, before we write down what medicines they need to buy. If the drug is not needed, we should desist from writing down a prescription only to pay back or please the last pharmaceutical company that sent us to some out-of-town lecture or pleasure trip to never-never-land. If the patient does not need a prescription, tell the patient that. Our prescriptions should not be clouded by the incentives or perks that come along with the "field trips" or "excursions" or "lunch baskets" provided the industry. I will go direct to the point - there is no gift that is given without an exchange awaiting. The bigger the gift, the larger the investment of the industry, the larger the expectation.

These conflicts of interest have begun to be scrutinized lately by several ethical, academic and governmental institutions both abroad and locally. Ironically, while it is the industry that now calls on the moratorium to the excessive spending and lavish wining and dining to doctors, it is also the industry that started this marketing ploy that has now caught them in between the devil and the deep blue sea. Like rearing children, the industry has spoiled the kids rotten. The phrase "spare the rod and spoil the child" aptly describes the old disciplinary method of not punishing children when they are caught doing something wrong. As a matter of fact you will hear tales from the industry that doctors literally ASK for anything under the sun - from cars to trips to furniture to laptops to mobile phones to sponsoring their annual dues or convention fees to driving them to and from the airport or picking up their children to school or asking med reps for personal "favors" in exchange for keeping a "close relationship" with the rep in particular and the pharmaceutical company in general. But that's because they allow it and that's because the industry is so deeply mired in this traditional exchange "gift" that the marketing people have not changed the old "tactics" of selling a product.

I tell my students that a good drug, sells itself. A bad drug, needs a gift to go with the bag.

Some of my friends who practice in the United States once asked me how some of my colleagues here are in several conventions in the U.S. or Europe or Asia in a year. When I asked them how they know, they tell me that they read it as "shoutouts" with matching pictures of various tourist destinations from some of our colleagues almost every other month! Some of them even post the pictures on Facebook with the signage of the drug product they were asked to pose and promote.

One of the biggest contributors to sponsorship as an indirect form of bribery are the various organizational societies themselves. Touted as pillars of the medical circle, some of them violate ethical boundaries by demanding from pharmaceutical companies sponsorships in conventions which they collect convention fees and some threaten companies of boycott if they do not "contribute" to the success of said conventions. When the pharmaceutical company agrees to sponsor an event like a convention, the society must maintain its unbiased position by ensuring that the sponsors do not in any form pose bias in the promotion of its company's products by unduly providing more exposure than the other sponsors with lesser financial means. If the society cannot police itself at the get go, how will it expect its members to follow suit?

The National Pediatric Infectious Diseases Seminar (NPIDS) sponsored by the Baylor College of Medicine in Houston spearheaded by Infectious Disease pillars Drs. George McCracken and John Nelson had discontinued their program after almost a quarter of a century of providing unbiased CME programs because they decided to adhere to more ethical standards in the conduct of the seminar. Because industry did not want to sponsor events where there would be less exposure to their products, the pharmaceutical companies threatened to pull out sponsorships if the organizers refused to give them more exposure. Because the cost of running the program without the aid of the industry was a tall order and prohibitive, the organizers decided that it was time to end the program rather than give in to the coercion of the industry. I used to attend this seminar for over 10 years until it closed down several years ago. It was a great loss but I admired the organizers for taking a stand.

The issue on conflicts of interest are not solely the problem of doctors. Each professional field is mired in its own conflict, but the medical field is the only one wherein a second person or more persons are affected by the decision made by the primary person whom that conflict is borne upon - a decision that can affect life, cost/benefit outcome in limited or scarce resources scenario, and burden of treatment or diagnostic procedure when the latter is not required.

During a meeting with one of the pharmaceutical companies, they had expressed exasperation at the attitude of some doctors whom they could not provide "gifts" to. Some of the doctors were either angry or in denial or were bargaining (agreeing to sponsorships for local conventions instead of foreign ones) and I was shocked that some even had the temerity to reply, "paano na ngayon?"

Truth be told, the doctors are one of the highest paid professionals - locally or abroad. Let's face it, our patients know that. They see how grandiose some can be - toting a Hermes or LV or Prada, driving an Audi or Porsche or Pajero, living in posh villages, wearing signature clothes with matching shoes, belts and bags and bling, dining in 5-star hotels or expensive restaurants. The mere fact that we flash around all these largesse and yet ask pharmaceutical companies for "gifts" in any form leaves a bad taste in the mouth.

I am not saying that we don't accept a gift. When a gift is given, it should not expect anything in return. After all, if it is a sincere gesture, it should not expect payback. If the gift provided is part of an exchange deal, then it should not be accepted. It is unethical to demand anything from a company. What the industry provides or gives us is a privilege and not a RIGHT!

Today's changing landscape in the pharmaceutical industry should be a reason why there needs to be a paradigm change on the Filipino physician's role with the industry. There needs to be a concerted effort at preserving the dignity of each of us in spite of the pressure of some sectors of the industry putting a carrot in front of the rabbit to make the rabbit hop!

After 10-15 years of studying to be the most distinguished profession in the world, we cannot let conflicts of interest destroy our integrity. At the end of the day, our patients should benefit from our judgement. They pay our professional fees, put food on our table, a house over our heads, send our children to good schools. They deserve nothing less than the best standard of care without undue influence from the pharmaceutical industry.

The circus came to town

It was a rainy weekend, with tropical storm "Falcon" pouring torrents of water in Manila (and the neighboring provinces). The streets of the metro was flooded and I had to cancel clinic on a Saturday.

Saturday was also the day that my family and I had bought tickets to see the circus that came to town. Le Cirque du Soleil had flown in over P700M worth of equipment, stage, acrobats and clowns for the first ever performance of Cirque in the Philippines. That Saturday afternoon, the weather had cleared and it was a childhood fantasy relived all over again.

Varekai was the Cirque version that performed in Manila. I had bought the tickets way back in February and had gotten good seats. Varekai had premiered in Montreal, Canada in 2002 and the plot is basically a take off from the Greek mythology of Icarus, the fallen angel whose wings had melted after flying close to the sun. Instead of drowning into the sea, he falls into a lush forest and the creatures and plants in the forest teach him how to fly again.

I have seen some of the other Cirque shows in Las Vegas and while Varekai falls short of the much more fantasmagoric shows of Cirque, its setting in Manila at a specially built Grand Chapiteau (circus tent) that was fully airconditioned, provided a good atmosphere to enjoy a circus. The show started right on the dot and the rules on no cameras, mobile phone conversations and other gadgets were fully implemented. On a negative note, I guess the full episode of Varekai was not shown because of the limitations of space, so the show simply lasted 1 hr 30 mins with a 25 mins intermission number.

The highlights of the show were the child performers, the clown acts and the grand finale that got ooos and ahhhs from the audience.

While I guess for those like me who had seen other performances of Cirque, Varekai had provided the entertainment to the locals. And I am hoping that this will not be the last performance of Cirque in Manila.

Varekai runs until July 24 at the Luneta Grandstand. And for those who may still want to catch it, get the tickets at the farther end at the upper rows so you can see the stage in full. We were watching from the very front row and had torticollis after the show.

Until the next circus comes to town...enjoy the fantastic spectacle that only Cirque can provide. It's worth the weekend.

Death by kindness

So you hate someone or you probably are angry at the world. You've been wronged and you want revenge. Who doesn't? In a culture where being "mean" can mean being "in", we've probably gotten a taste of the sore end of being bullied.

There's a story that goes like this:

"A newly married woman was to live with her mother-in-law. On the outset she noticed that her mother-in-law was a little devil. The mother-in-law saw nothing right about her whatever she did in the house. Disturbed and devastated, the young wife went to a chemist-friend and asked for some poison to kill her mother-in-law slowly. The friend gave her a potion that she would drop little by little into the coffee of the mother-in-law who would drop dead in a month. But the friend strictly advised the young wife to be very patient and kind to her mother-in-law so as not to attract attention to her evil design.

So while slowly poisoning the mother-in-law, the young wife treated her very sweetly and kindly. Soon after, the mother-in-law changed and started treating her daughter-in-law very sweetly and kindly, too. This made the young wife guilty and ashamed of what she was doing. She went back to her friend, crying and begging for an antidote to the poison she had been giving her mother-in-law.

Her friend just smiled and said, "that was no poison I gave you, but just some baking powder. What killed her was our kindness. Go home and continue to treat her as you would want to be treated."

The message is clear and simple. We get treated the way we want people to treat us or the way we treat people in return. Sure, there are mean people and sure, we lose our tempers from time to time. No one is born perfect. But in each and every act of kindness we give, we get kindness back in return. Maybe not from the same person...but from other peoples.

A bit of compassion, understanding and love. A piece of our heaven, our purgatory and hell in our journeys in life.

[Photo from John Sokol: AIM ABOVE THE MARK]