Tuesday, March 29, 2011


In Tagalog, it means stupid.

I have been reading the various articles regarding the last escapade Willie Revillame has had with respect to his game show.

The most recent incident involved a 6 year old boy named Jan Jan whom Willie R had apparently plucked out of the audience. For P10,000 (about $230), Jan Jan was asked to dance. While the boy was dancing, Willie was reportedly laughing like a lunatic and making uncouth comments about the boy not smiling while being asked to gyrate like a macho dancer. And the comment was that the boy was not even smiling (Have you ever been to a gay bar and watched a macho dancer dance? Well if you haven't, I have and I have never seen them smile. But if you put money in their underwear they will thank you for it. Even if you palpated their genitals, they will allow you to touch their private parts. They will not complain because it's all about the money.)

This episode of his game show had drawn flak from various sectors of society. Well, specifically, the well-off. Those who had commented on this apparent abuse were, sad to say, mostly (if not all) from the middle and upper class.

Well bless your bleeding hearts!

Time and again, I have blogged about Willie R. Let me get it straight to my readers. I AM NOT A FAN!

I occasionally watch the tirades of Willie R and when I do get the chance, his show, in order to provide a critique.

I will not defend Willie R in this blog.

All I can say is we get what we dish out.

Let me be frank. Willie has the money to give. Lots and lots of it. But like all the local game shows and their hosts, what they give out in cash or prizes are at the expense of the audience. Those lacking not only in brains, but also in cash. Those of us who denounce these practices are simply kibitzers of the ongoing saga of the local media making "bobos" out the the Filipino people.

Let's face it. It's not only the game shows that are apparently a reflection of the dire attitude of the Pinoy viewer. It's also these inane and mundane telenovelas that seem to have a following. From Machete to Captain Barbel to Darna to Mara Clara to even the Korean telenovelas where the lines are dubbed in Tagalog. And the Pinoy viewer will always have a penchant for the slapping, the killing, the abuse, the fantasies and the inuendos that actually come out of the boob tube. We only have the media to blame for this. After all, as I always say - there is no greater fool than the fooled by a fool.

Bakya! Jologs! Whatever name you give it, local showbiz will always have a way of making the average Pinoy viewer a pathetic empathizer and follower of what is characteristically a no-brainer.

I had asked my driver the scenario that happened on Willie's show. If I gave your son P10,000 to gyrate on television, would you? And I was not surprised at the response. It was, after all big money. He added, after all, it was only a gag and even if people made fun of it, it was a once in a lifetime. My driver wasn't complaining. Neither were the parents of Jan Jan.

So why are we making a big issue out of it?

The news from the grapevine is that the first report of this "dastardly" act of Willie R was from a reporter for the Philippine Daily Inquirer. Another media person. The PDI is closely (read closely) affiliated with GMA 7. According to my source, none of the complainants actually had a clue of what went on in the show. Not until the reporter had the commentary published in the PDI. The drove all the techies and bleeding hearts into a "Kill WIllie" frenzy. As we all know by now, both GMA 7 and ABS-CBN had been having a run for their news ratings since the show of WIllie on TV5 had barged into the same time slot as theirs. Report is that the current share of the ratings is now equal. So this puts both channels 7 and 2 in a precarious spot wherein they need the advertisers, but the latter have been trekking to the show of Willie R. What better way to destroy the show of Willie than to find a story?

So we want to destroy Willie R. What better way than to:

1. Not watch his shows
2. Not buy his records (God the guy can't even sing but he's the best selling artist, outselling Martin Nievera, Gary Valenciano, Sharon Cuneta and Christian Bautista combined).
3. Not buy Bench items (He has a perfume to his name. It's also the best seller)
4. Not purchase anything he endorses. (From Happee toothpaste to Camella homes)
5. Not buy tickets to his concerts.
6. Ask the advertisers to pull out of his shows.
7. Boycott TV5
8. Not cater to anything that Manny Pangilinan owns or runs (which i doubt can happen because he practically runs all the utilities and roads and properties and major hospitals in the country).

But I doubt if we will do most of the suggestions I provided above.

Truth of the matter, however, is that it's the lower class that happen to be his rabid followers. No matter what we do, no matter how much stones we cast on him, he will outwit and outlast all of the kibitzers and complainants. He has the money and in fact is the top 5 taxpayers in the Philippines. He pays his taxes on time and correctly. Something I doubt, even these do good die hard detractors do. In short, with the over P15M that he has paid in taxes last year, he has contributed - again - to the poor and the projects of the Philippine government. Much more than what his detractors have.

What Revillame does in order to earn money, whether right or wrong, is for the people the judge. And like other local actors and actresses that have a rabid following in spite of the wrong that they do at the expense of other people, he is not alone in this endeavor. Kris Aquino has the penchant for maligning a contestant on her various game shows. Edu Manzano will make someone dance like a chicken so that the idiot has shot at fame for a few seconds. Vic Sotto will belittle the capacity of a studio contestant in a game show if the guy can't even get a simple question answerable by a grade 1 student correctly. Vice Ganda will make a fool out of a dance contestant by mocking him or her as if he was still running a comedy bar. Or how wrong it is to be followers of TV personalities who endorse medicines, herbal supplements, and even the wrong kind of food or drink!

And the weird fact here is that we're so worried about the 6 year old who was thrust into a few seconds of fame and money and controversy, when his family were even encouraging, nay, ecstatic over the boy dancing like his future job! Whether these TV personalities bully a young lad like this or an adult who is mentally challenged is no reason to allow the ridicule based on the age of a person.

If Revillame rolled over and died today, I would have no remorse. But the millions and millions of followers would probably make Cory Aquino's wake and burial look like peanuts.

As long as local media operates the way it does by making our televiewers more "bobo", there is nothing we can doing for now. This, my friends, is the sad, pathetic world of local showbiz.

And in the world of showbiz, a controversy will always make a star!

By creating this buzz about Willie R, we have simply added a notch for him in his claim to fame. He will apologize (as he always had) and survive this. And we were taken for a ride. We have made him more popular now and the rabid fans will always be at his side, to the rescue.

We just need to stop making this fool famous.

Sunday, March 27, 2011

True colors

There's a saying that goes "you can take the boy out of the country, but you can never take the country out of the boy."

This saying is most personified in the boxing celebrity-cum Congressman of Saranggani - Manny Pacquiao.

Fine, he's a great boxer. There's no question about this. The guy has talent. In the boxing ring.

I've blogged about his rise from rags to riches. Including the saga of his mom - Aling Dionisia. (I refuse to call her Dona Dionisia, she doesn't deserve the title). CongMP (his name in his Twitter account) has brought accolades to the Philippines because of his boxing prowess. Then there are his charitable works as well. My hats off to him here.

But off the ring, I don't know what kind of unseen spirit had swooped upon the guy that he needed to run for Congressman in the district of Saranggani in General Santos. Alright, so the people of Saranggani had spoken. He won the election fair and square. And CongMP went to some form of crash course in political science or something to that effect in a school in Manila. The professors came out on television, praising Pacman for his being astute and a good student.

Just as he was beginning his political career, Pacman needed to take a leave of absence from his duty as an elected public official because of his fight match against Margarito Teves last November 13. His training days took him out of work as a pubic official. Understandably, with what he can legitimately make as a congressman is peanuts compared to what he can make in one fight. His winning the match against Teves had put him on a pedestal a notch higher.

After the match, congress went on a holiday break and so did Pacman.

The next time congress was in session he needed to take another leave of absence. This time to prepare for his match against Shane Mosley this coming May.

And during his promotional tour in the US and training in the Philippines, CongMP was always absent from Congress. But wait, here's the news. In spite of his absence, he tweets. Yes, he apparently has a Twitter account and announces his day to day progress and "news".

A Twitter follower of CongMP had inquired on why Pacman was always absent in congress and questions if he was fit to be a congressman considering the fact that he is never around for his duties as an elected public official.

This triggered a reply from CongMP with a tweet saying "itanong mo sa lolo mong panot" [ask your bald grandfather].

The following day, during the impeachment of embattled ombudsman Merci, Pacman was nowhere to be found. Training in Baguio, the guy didn't even have the balls to go to congress to make a milestone decision for and on behalf of his constituents. Instead, he tweeted that he votes for NO to the impeachment of Merci.

This sent a lot of people becoming irritated with the conduct of Pacman as a public official. And triggered him to closing his Twitter account.

It is sad that the people of Saranggani will have to bear with Pacman as their duly elected representative for 2 more years (he's been in office for a year already). Somebody is running the show as congressman in their district and it definitely is not Pacman.

Alright, so the guy has moolah and the guy is now dressed in all the designer suits money can buy. He has rubbed elbows and hobnobbed with the rich and famous. He has guested in the White House and maybe we can say that Barrack Obama is a fan [I have no idea what is in the mind of Obama but this is one president that seems to have periods of lucid intervals]. He has been on the cover of so many magazines including Time magazine. He has everything with respect to fame and fortune!

And as a boxer, I have no doubt on the skills of Pacman.

Etiquette and breeding is something that is learned through years of formation. It is not one that flows freely overnight just because you have money. Somewhere in between all that glaring cash, someone thought that it would change his personality and all that hillbilly attitude would be covered up with so much Rolex and gold and diamonds and dollars and cars.

True colors will always show during the most trying time. And Pacman has just shown his.

Question is, do the people of Saranggani and his rabid followers see his true colors or are blinded with the color of money?

Thursday, March 24, 2011

The execution

For the record, I am ambivalent about the death penalty.

Alright, so I don't have a stand with respect to this issue. But you will have to agree with me that there are circumstances when you feel that death by execution is so right and there are times when you think that it's so wrong.

There will be always two sides to an opinion and I have seen how divisive a religious conviction and belief is towards a moral issue. The RH (reproductive health) bill has created enemies from once upon a time friends because they took different stands in this brewing controversy.

If I am following the like of reasoning among pro-life advocates, then that means that all who are opposed to the reproductive health bill are also opposed to the death penalty. Life, after all, irregardless of whether it is a sperm and an ovum that will not be joined together because of a condom or some artificial barrier OR whether it is death by lethal injection no matter how grizzly the criminal act of the accused is, is still anti-life.

As we all know by now, the story of the 3 Filipino drug mules whose execution in China last February brought the country to a stand still with media focusing on their stories like a telenovela sob-story poor-boy/girl-needed-money-criminal act-justification rationalization. After some cause-oriented group (and there's always some groupie to that effect in this country, with media in particular) cried out of destitute to stay the death sentences of these Filipinos who were found guilty of drug trafficking in China, swath-buckling VP Jejomar Binay took the next flight out of Manila so that he can beg for pardon from the Chinese government on the execution. On Binay's return, the press had hailed his bravado because a proud Jejomon had stepped off the plane smiling proud that there was a stay on the execution.

The Chinese government, however, made it explicitly clear that it was not changing its mind. The execution would push through at some period in time. Jejomon had a ready reply to this - as long as we buy time, anything can happen and who knows, a miracle or divine intervention may change the landscape of things.

Wishful thinking...

And as I was reviewing the events that lead to the execution of the 3 Filipinos, I could not help but feel...ambivalent.

Time and again, I have said that we cannot always use poverty as a reason for doing something wrong. Otherwise, with 75% of the Filipinos living in the Philippines living below the poverty line, we will have gazillion reasons to rationalize a criminal act.

So what can we do to minimize this? We need good governance and stamp our graft and corruption so that whatever resources are meant for the people are given to the people. We need to clean up the government's image first and foremost and punish those who use government and political connections in order to enrich themselves. And we cannot do that unless we send a clear message to those in public office that crime does not pay. Unfortunately, that is not the case scenario in this country. It will take more than PNoy to make this miraculous vision work, but today is a good beginning.

We need to make the Church understand that it cannot always meddle in politics. While there may be teachings and beliefs that are contradictory to what lawmakers may suggest, the benefits for the public must be weighed against the risks or ideologies. Ideologies do not get a country far. It becomes divisive and does not protect the greater majority from harm than good. While many religions preach from the various pulpits, they need to translate these teachings into more tangible education in changing the current practices or simple discipline to our people. We cannot keep saying NO because a noisy few are powerful enough to create the noise. We need to make sermons more relevant to the masses. And the various religions that are against death penalties and other government laws must be consistent in providing an alternative to a problem as well as making a stand not only in terms of their ideologies but against any harm to human life as well.

We need to teach discipline and responsibility across all classes of society. Easier said than done. But it's a start. That's why kids go to school. We need to educate them on what is right and what is wrong. How to cross the streets properly, why not to allow smoking even within campus and around campus, the need to fail when one does not cut the grade, why bullying is not acceptable, why falling in line is a rule everywhere and not only done in school, why we need to respect the Philippine flag...little things which must get cascaded and practiced at home as well! The problem here is that parents and relatives behave differently and this confuses the child who is growing up. Why is it that it's alright to cross the street anywhere without having to use the overpass and pedestrian lane when they're with their parents? You see this as a daily exercise in futility and you see the traffic enforcers busy catching number coding cars (because that's where they make a living) rather than instill discipline among pedestrians and public utility vehicles that ply the angry streets of Metro Manila (because they believe that they are their peers).

I commiserate with the family of the 3 Filipinos for execution in China this March 30. Like many other citizens worldwide who are at the throng of death because of crimes which they committed, I can only say that it is one's responsibility on how they live their lives. The government should not and cannot spend public funds meant for the development of its country and peoples in staying the execution by sending vice-presidents or other public officials to beg for clemency and mercy. If we will be doing this, there will be no end to the criminals and their families seeking for help from the government each time they commit a crime. We would have needlessly and recklessly spent public funds aimed at alleviating lives that are worth saving than letting these criminals go scot free.

I cannot understand why some sectors in media make a big issue about this execution. They write up their stories about being poor and taking on this criminal act because they come from poor families and wanted a better future for their families and themselves. Fine! Who doesn't? But trivializing this by making it seem like a sob story is irrational journalism! There are better stories to write about, without having to make a mistake a sensation!

There is a saying that when in Rome, do as the Romans do. It's why Filipinos who go to Singapore, Malaysia and other developed countries seem to more behaved and disciplined than those left behind in the Philippines.

I am quite sure that the 3 Filipino drug mules knew the risks they were taking when they brought in 10kg (that's heavier than a bowling ball) of cocaine into China. There are more drug mules (Filipinos or other nationalities) worldwide. And illegal drugs and drug trafficking is the reason why more lives are lost and destroyed. Like a disease, you need to cut the vector so that the patient does not get infected. If the death penalty is a way to dissuade a criminal act that results in more deaths, so be it. And while there are bleeding hearts that claim that the end does not justify the means, I can only say that they can take the saying and shove it up their a*s.

There are arguments for and against the death penalty. And while it is true that there may be SOME people who meet the death penalty but are innocent, there are those that are freed but they have committed a crime. The justice system is blind and the problem is not the punishment but how to make sure that we all get a fair shake at justice. You don't need to look far. See how the generals are being treated with kids gloves and the number of politicians that actually don't get convicted because they have the money for better lawyers or shady deals with the judicial system.

For now, the vector must die.

Friday, March 18, 2011

The lessons learned from a disaster: Japan earthquake 2011

Japan lies in an area around 4 tectonic plates. Hence, it is one of the most dangerous places to live on earth, in terms of being prone to earthquakes. Surrounding Japan is the vast Pacific Ocean. Because of the topography of Japan and the unpredictable nature of calamities, disaster preparedness is unrivaled in this country. As a nation, the Japanese have learned many lessons from it's previous skirmishes with nature. Aside from earthquakes and tsunamis, its southern section is often battered by storms during the monsoon season.

Yet no matter how prepared we are, nature finds its way to being unpredictably ferocious and ghastly. it can reel an ugly head and it was a beautiful cool spring afternoon when the magnitude 9.0 earthquake hit the northeastern part of Japan on March 11, 2011. The aftershocks came a few minutes apart. While the houses and buildings in Japan were built to withstand frequent tremors, it was not prepared for a deadly aftermath. After a few minutes of silence, an angry wall of sea resulting from the earthquake had rocked the seabed. Moving at great speed, it had wiped out the city of Sendai. What survivors were able to capture on video and shown in various news stations was frightening as wave upon wave of water swallowed life in all forms, and pummeled a town to oblivion.

And as if the wrath of nature had just devastated a whole prefecture, the man-built nuclear reactors in Fukushima prefect had given in. In 24 hours, reactor 1 had blown up and a meltdown was inevitable. To this writing, several reactors in the Daiichi plant were still not contained. As the Japanese government scrambled to fix the nuclear crisis, it was inevitable that this daunting problem would be their most challenging since World War II.

People scrambled to get out of Japan while many sent aid to Japan as well.

What is most astonishing is the resolve of the Japanese people, their extraordinary courage and discipline during this time of crisis.

As kibitzers we simply watched the news on how the Japanese braved the cold, the hunger and the pain of loss. There was no howling or hysteria. There was no looting. In the various aid centers that housed the displaced people, you could see a sense of pride in the way they queued for food and water, in their sharing of clothing and shelter among each other, in the way they were handling the crisis and in their resolve to build again from the rubbles.

The Fukushima 50 story of 50 people who work in the Daiichi Nuclear Power Plant who volunteered to risk their lives so that many will be saved was a story of unprecedented heroism. They knew that in spite of the health risks to them, they said their last goodbyes to their families and loved ones and gallantly braved the odds to save a nation and its people.

And then it snowed during the rescues and recoveries and the death toll became insurmountable. Yet they braved the wrath of nature to save lives overcoming these odds.

While some country heads and kibitzers in media express global concern over another nuclear reactor meltdown and how it would affect neighboring countries, the Japanese are being faulted for not asking for more help and not being "truthful" about the situation with respect to the nuclear reactors in Japan.

I have been to Japan several times because our head office is located there. Each of these trips are filled with good memories. The people are kind, warm and respectful. In spite of the fact that they have the most advanced technology in Asia, if not in the world, their people are deeply rooted in a culture of respect and tradition.

I blog about this today as I condole with the Japanese people during this time of crisis. I salute them and bow to them for the kind of discipline and indefatigable love of country and people. No country in the world has seen this kind of determination to rebuild from the rubble without having to resort to having to take advantage of those who had less. I envied them while I watched in horror at the scenario and awe at how they resolved to overcome the adversities of war, nature calamities, economic recession and life in general.

Random thoughts occurred to me while writing this blog. In spite of the tremendous advancements in technology and science and the internet and hi-fi sci-fi gadgets technological companies have created, we have never unraveled the mystery on how to detect an oncoming earthquake or prevent nature's unpredictable behavior and its aftermaths.

I guess nature is so much like the science of medicine. We will never have answers to finding a cure for AIDS, for cancer, for long life, for regeneration of youth and other mysteries that have never been unraveled in spite of the advances we have made.

There are some questions that do not have answers...yet.

Transfiguration in the Catholic religion is not just a story of Jesus Christ, "it is about hope rising, courage emerging and love lifting us up."

Because the Japanese have found life's mission and purpose, they will overcome all odds.

We can learn a few lessons from this noble race.

[Photos from the following:
(AP Photo/Asahi Shimbun, Naoko Kawamura)
(AP Photo/Kyodo News)
(AP Photo/Gregory Bull)
(AP Photo/The Yomiuri Shimbun, Tsuyoshi Matsumoto)

There are moving photo essays from this website. I highly recommend it to all.

Monday, March 14, 2011

Fever is your friend

I remember a few years ago in one of the lectures of Dr. Sarah Long, former President of the Pediatric Infectious Diseases Society in the United States, emphasizing that "fever is your friend".

It was a simple message. In a nutshell, fever is the immune system's way of recognizing a foreign invasion on our body. Fever is a reaction from this invasion and is the body's defense on this foreign invasion.

The American Academy of Pediatrics recently published "Clinical Report: Fever and Antipyretic Use in Children", written by Janice E. Sullivan and Henry C. Farrar from the Section on Clinical Pharmacology and Therapeutics, and Committee on Drugs [Pediatrics, published online February 28, 2011]. I have time and again explained to my patients parents and guardians on why they should not unnecessarily panic when their children have fever and when to or not to give antipyretics.

Let me summarize the highlights of this report:

1. Appropriate fluid hydration is still the best treatment for fever. Fever results in insensible water losses. This includes a few electrolytes and water when patients have fever. Simply replacing these insensible water losses will not only help bring down the temperature of the patient but will help rehydrate them as well.

In short, when the patients have fever, it is important to take a lot of fluids.

2. "The desire to improve the overall comfort of the febrile child must be balanced against the desire to simply lower the body temperature." This is the most important factor that triggers the domino effect of panic among parents/guardians regarding fever in children. The psychological terror of "fever phobia" is taken out of context and the disproportionate reaction is more often than not due to myths and misconceptions on fever and its sequelae - seizures, brain damage, and death.

And the doctor is just as culpable in fanning the flames of undue panic by not providing education and being trigger happy in giving a prescription to patients with fever.

"It is argued that by creating undue concern over these presumed risks of fever, for which there is no clearly established relationship, physician are promoting an exaggerated desire in parents to achieve normothermia by aggressively treating fever in their children."

3. "There is NO EVIDENCE that reducing fever reduces morbidity or mortality from febrile illness. Possible exceptions to this could be children with underlying chronic diseases that may result in limited metabolic reserves or children who are critically ill, because these children may not tolerate the increased metabolic demands of fever."

4. "There is NO EVIDENCE that antipyretic therapy decreases the recurrence of febrile seizure."

5. Regarding immunization and fever, many pediatricians recommend either pretreatment with paracetamol or ibuprofen before immunization or immediately after immunization to minimize the discomfort associated with injections and minimize the febrile response. "...results of one recent study suggested the possibility of decreased immune response to vaccines in patients treated early with antipyretics." In addition, fever as an adverse reaction post-immunization accounts for only <10% of reactions. Putting patients at risk for adverse events from drugs being administered for no reason at all makes one wonder whether the benefits will actually outweigh the risks of giving drugs.

6. "Although the available literature is limited on the actual risks of fever and the benefits of antipyretic therapy, it is recognized that improvement in patient comfort is a reasonable therapeutic objective. Furthermore, at this time, there is no evidence that temperature reduction, in and of itself, should be the primary goal of antipyretic therapy."

7. Paracetamol (Acetaminophen) or Ibuprofen?
Once upon a time, salicylates was the drug of choice for fever. After sufficient data emerged associating salicylic acid (aspirin) and Reye syndrome (hepatic encephalopathy after aspirin administration with specific viral illnesses), paracetamol eventually replaced aspirin as the treatment of choice for fever. However, paracetamol is NOT without problems. Contrary to the endorsements of John Llyod Cruz regarding paracetamol being absolutely safe and seemingly taken like M&Ms for even minor aches and pain.

Paracetamol is the number one cause of drug-induced liver toxicity worldwide. Hepatotoxicity is most commonly seen in acute overdoses and the most common scenarios are in children receiving higher doses of paracetamol at intervals of less than 4 hours or around the clock!

"One safety concern is the effect of paracetamol on asthma-related symptoms; although asthma has also been associated with paracetamol use, causality has not been demonstrated."

Ibuprofen has gained popularity as an antipyretic. Ibuprofen is a non-steroidal anti-inflammatory drug (NSAID). It has very potent anti-inflammatory effect and is widely used for the treatment of rheumatologic problems. Its increasing use in managing fever is probably due to the longer clinical effect at lower doses than paracetamol.

"There is NO EVIDENCE to indicate that there is a difference in the safety of standard doses of ibuprofen compared to paracetamol in healthy children between 6 months to 12 years old with febrile illnesses". Like all NSAIDs, ibuprofen can cause gastritis, bleeding and ulcers of stomach duodenum and esophagus. Unlike paracetamol, ibuprofen has no evidence linking it to worsening of asthma symptoms.

Concern has been raised over the nephrotoxicity of ibuprofen. Because of the increasing reports of renal insufficiency in children treated with ibuprofen or other NSAIDs for febrile illnesses, caution is encouraged when using this drug in children who have fever with dehydration or with complex medical illnesses.

"Children who are at greatest risk of ibuprofen-related renal toxicity are those with dehydration, cardiovascular disease, preexisting renal disease, or the concomitant use of other nephrotoxic agents. Another potential group of risk is infants younger than 6 months because of the possibility of difference in ibuprofen pharmacokinetics and developmental differences in renal function...Another potential risk associated with the use of ibuprofen is the possible association between ibuprofen and varicella-related invasive group A streptococcal infection."

The management of fever is understanding why the patient is febrile. Parents/guardians must be made to understand that fever in itself is not known to endanger a generally healthy child. As I explained in the beginning, fever in itself may be beneficial to patients as it is an indicator that the body is fighting off a foreign intrusion into the immune system. The goal of antipyretic therapy is not to simply normalize body temperature but to improve the overall comfort and well-being of the patient. Hydration,education of parents/guardians on the use/misuse of antipyretics and diagnosing the actual cause of the fever by focusing on the other signs and symptoms accompanying the fever can help promote appropriate drug prescription in this vulnerable population.

After all, it is our duty as health care providers to FIRST DO NO HARM.

Thursday, March 10, 2011

Telenovela, Pinoy style

I got a text the other night asking me why Mara (from the Telenovela Mara Clara on ABS-CBN) died in the teleserye.

I texted back saying I had no idea!

So I rushed to my mom's room and asked her why and how the character Mara died. I was aghast because the maids (who were watching the series) were sobbing! Sobbing!!!

Then my mom talked about a love-hate relationship and who was jealous with whom and then a bomb being set off and Mara dying eventually.


I said, "well it's about time the characters get killed somehow. These telenovelas in the Philippines look like the stars and characters have super duper long lives. They get slapped, kicked, shot, stabbed, buried alive, hanged, castrated, raped, gang raped, and raped some more....and then they are run over, tortured, abused, hit, and killed over and over and over again...but there's still a happy ending. I remember a few years ago when I was watching a telenovela which had a good story line. Somewhere along the way the lead character died and I thought this was the ending. Well since it had run for almost 3 months, it was, I guess time to end the sob story. But because the ratings went well, the greedy TV networks decided that it should stay on. So they decided to resurrect the character."

Seriously, I have attempted several times to make sense out of these telenovelas. Which means, YES I attempt to watch some of them, especially those that seem to have a story to it. I really don't know if it's me or it's how pathetic the writers of these telenovelas make a short story seem like it can run forever and ever and ever in a land far far....very very very far away.

It gets tiring after awhile. I mean, let's face it. Even grade 1 students can tell a better story and these networks actually PAY these people to write? The theme is usual - boy meets girl, girl meets boy, they fall in love and a love triangle or quadrangle ensues. Then there should be the "contrabida". Who will not only maim and kill and slap slap slap slap the protagonist but the script is so craftily written to the point of giving new meaning to the word torture. With so much human rights abuse, I don't know how this gets tolerated by human rights advocates. Of course, religion will never escape the part. There should be a priest who is either Padre Damaso or who is kind, caring and then dead. And don't forget the cop. More often than not, there is a rogue cop and a circle of rogue politicians. Oh oh...there's always the bitch in tow. There is always the querida and the other woman or the boytoy or the macho dancer. The rich will always need to oppress the poor. The more oppression the better!

And the acting of some of the actors/actresses are not only terrible but downright shameful. Some shed clothes to the barest with no acting ability whatsoever. They cannot even deliver a line! Take the guy in Machete. He's as pathetic as it gets. Enough said.

My mom and the maids pass their time watching Korean, Taiwanese, Japanese, Spanish, and of course, Filipino telenovelas. If I gave my mom a pop quiz on these shows, she'd probably score 90 and the maids 100.

As to why and how these sagas last is beyond my comprehension. I guess we just need to cater to the basic things that the Pinoys like - and that's doing nothing in their spare time.

Someone has got to just go ahead and shoot the TV set.

By the way, the other night, the maids began clapping and screaming. I thought the dog did a swan dive with my cat.

Guess what?

Mara was resurrected. [Talk about nine lives! Parang pusa talaga ang mga bida sa teleserye!]

And the saga continues...

Sunday, March 6, 2011

The bystander and the complainant

It's like clock work. More often than not, I reserve my Tuesdays for my mom.

A few years ago, we were at the Alabang Town Center mall. After lunch, we were talking about our upcoming vacation. She was holding on to my hand. Out of nowhere she suddenly tripped on an open wire that jutted out from the flooring of the mall. The mall has wires that jut out of the floor to provide lighting and other electrical access to the cart-wheel stores found in the middle of the mall alleys.

It was an unforgettable and unfortunate accident. My mom did a somersault that would put the cast of L'Cirque to shame. She landed head first and her bounced once on the tile-cemented flooring. What resulted was a concussion from the fall.

A colleague of mine was there and she rushed to help.

The sales people in the various cart wheel stores were just watching us. Yup, just watching.

I asked the maid to go look for a security guard, who as usual, was nowhere around when you needed one.

It took awhile before the guard arrived and someone from the Healthway Clinic came in tow with a wheelchair.

We were brought to the mall's clinic where my mom was eventually examined. There was a big lump at the back of her head as as the area of trauma began to swell, I told the doctors there that I thought she should be brought to the emergency room of a hospital. We stabilized her blood pressure, which shot up due to the fall. When she was feeling a little less dizzy, I told the Healthway people that I was moving her to Asian Hospital for a CT Scan/MRI.

Initially, they didn't want us to leave until we settled the bill at Healthway. I became infuriated. In the first place, the accident would not have occurred if the mall owners/managers had made sure that the wiring connections on the floor had been sealed well! While the mall owners would like to earn more rent money from the open spaces, they should make sure that the wiring should be under the floor where it is hidden and will not cause accidents like these. But because it was cheaper to make "humps" on the floor rather than dig and and replace some flooring tiles, this is the result of their being cost-restrained. To make the long story short, I refused to pay and told them to go ahead and bill the mall owners. The receptionist at Healthway decided to call the administration office of the mall, but no one could take her call. They were on an excursion!

"Could you pay first and then go charge it to the mall later on?", the receptionist told me.

"No! Where in the world are these people? No one to take the complaint or act on this incident except the security guards?"

I did not want to argue further and because some of the doctors there were my students in medical school, they talked to the billing section and let us go.

I was glad that the CT Scan/MRI turned out to be negative and that the sustained injuries were external. But my mom had to stay a week in bed and had to see her cardiologist after. Of course, the sustained injuries from the fall made her more depressed.

I took the receipt, sent an incident report and a letter of complaint and the bill for the CT Scan/MRI to the mall.

While they did reimburse the ancillary procedure, it took them 2 weeks to do that.

So why do I blog about this incident?

A month ago, I noticed that the parking space of the Alabang Town Center was unusually crowded and as you can see in the photos, the sidewalks which were actually designed and built for handicapped and the disabled are now motorcycle parking. I called the attention of the lady security guard manning the door of the mall.

As usual, if you talk to people with less cerebral capacity you would get nowhere.

The lady guard argued that it was reserved parking for motorcycles. I argued back that it was not. It's a sidewalk. Not a parking space for motorcycles. The mere fact that there's a sign on the walk that clearly states it's for handicapped and disabled people mean that it's for people. NOT FOR MOTORCYCLES! There is a pay parking right beside. That is where motorcycles should park.

What surprised me was her ludicrous rebuttal. She said that most of the people who owned the motorcycles were employees of various merchandisers in the mall. They are poor and will not be able to afford daily parking fees of P20. She went on to say that with my attitude, I was undermining the poor!

I wanted to actually slap her right there and then. You can tell from the guard's argument that she was ranting about the travails of the poor. I hate it when people use poverty as an excuse for not following rules, regulations and laws. You can afford to buy a motorcycle, pay for gas and maintenance and registration, well I guess you can pay for parking as well. If these people have an issue about the parking fee, go complain to the administration like me!

Since we were getting nowhere, I told her to call the head of security or whoever was in-charge of the parking area. She told me to go their security office (and she pointed me in that direction).

I told her that i wanted to talk to the person in-charge right here and asked her to make him come here so that I could point to him what I was complaining about. I needed to visually show them what they drew on the pavement (the disabled sign) was not in congruence with the policy they were implementing. Besides, I was the customer! Gosh these people!!

Finally, the security head (or whoever the guy in-charge was) came and I explained to him the same argument I gave the lady guard. The guy I talked to said that he would do something about it.

It was a Tuesday and my mom and her yaya were in tow. My mom told me that I should stop arguing with people and stop complaining too much.

Over lunch, I told her:

"You see, that's what's wrong with people. You see something wrong and you let it go. You know it's not right and you shrug your shoulders. Until an accident happens. You remember what happened to you inside the mall a few years ago? This is another scenario where an accident is waiting to happen. I don't complain because I love to complain. Who in the world is insane enough to be just preoccupied with complaining? But when it's not right or there's something blatantly wrong, we need to take action even in the simplest way of opening our mouth. After all, it is only saliva that is lost here."

"I receive forwarded emails from friends and colleagues about being careful during these difficult times. The forwarded emails talk about being robbed in broad daylight or being harassed by officials and some punk simply trashes your car or belongings in front of other people. BUT THAT'S ALL WE DO. FORWARD THESE EMAILS! I have nothing against technology and the sharing of stories (which sometimes are downright scary or downright scripted to the point of being unbelievable). In all these forwarded emails, I have always wondered what the people whom we call bystanders (miron) actually did!"

"While I understand our skepticism in being good samaritans, we need to get out of the comfort zone of simply being bystanders. That's why nothing gets done because we're wimps. When we find something outrightly wrong, we need to speak up. We cannot be all bystanders. We need to make these changes even in own little way. We cannot be a passive people who simply sit back, relax and watch the world go by."

The other Tuesday, we had lunch again at the mall. My driver had parked in the same spot. And the motorcycles were still where they were one month ago. I called the attention of the roving guard but he just said that they'd do something about it. I decided there and then to go to the administration office. It was 1:00PM and why was not I surprised that the receptionist there told me "they're out to lunch and no one will be back until about 1:30PM" . So much for working for Ayala Malls where these people really take very very long lunches. I left my mobile number and told them to give me a text when the managers got back.

My mom and I had lunch and at about 2:15PM, I still didn't get a text. I guess they just wanted to forget about it. I went back to the administration office and they made me wait until about 2:35PM when two people came to talk to me. I told them my concern and showed them the pictures I captured on my iPhone. They appeared shock (or perhaps they've been nominated for best actor and actress in a supporting role for Ayala Malls). [Darn, it's right in their parking lot and they don't know?!?!?! Dang!!!]

It ended with a promise (promises are meant to be broken) that they'd do something about it. Soon?

I really don't know. But I promise that I will not stop until what is wrong has become right.

It is my own little way of not simply being a bystander!

Tuesday, March 1, 2011

Scarred for life

There is no day that passes without the news channels feature at least a story of someone who was abused.

There are various forms of abuse and the most vulnerable - women and children - suffer the worst.

I recall when I was a pediatric resident that I saw a 5 year old boy in the emergency room whose palms had signs of 2nd to 3rd degree burns. I was alarmed and looked at the boy who held back his tears while I was doing a full physical examination. The person who gave the history of what happened was the stepfather who had accompanied the boy to the ER. He said that the boy burned his palms because he was naughty and that he had lifted the cooking vessel not using the handle of the vessel. I did not buy the story so I went on to look for signs of physical abuse like a hematoma or a recent bruising, but there were none. I told the stepfather that we needed to take an x-ray (which I thought must be done to look for both old and new fractures that would tell me that the boy had been abused for quite some time). He told me that it was not necessary and that they were just there to have the wounds seen and dressed. I wondered where the mother was, and asked the boy, but the stepfather always answered all my queries. I asked the stepfather if it would be alright if I talked to the boy alone, but he got angry and said that I should mind my own business and just treat the visible wounds. During my residency, there was no Child Protection Unit yet and physical abuse was a dime a dozen, especially among the lower socioeconomic class of society. Even when I insisted on other work ups, the stepfather would side step my requests and we ended up with him walking out of the ER with the boy in tow. He said that he was bringing him somewhere else.

After 2 hours, an elderly woman had come looking for the boy and the stepfather. When I told her that they had left without being assessed, she hurried out the door. I ran after her to ask her who she was and she replied, "I'm the grandmother". I asked her if I could ask her a few questions and she just looked at me with tears flowing and said that the boy did not burn his palms accidentally. The stepfather was angry that afternoon because the boy had broken something. In a fit of rage, he dragged the boy to the kitchen and lit up the stove and forced his palms open and placed his palms over the electric stove. She then left immediately.

That was the last I saw of them.

Abuse can come in various forms - verbal, emotional, physical and neglect.

And children who are abused early on in life suffer the most. That's because they're vulnerable and are helpless from the abuser.

Children who have been physically abused present with a multitude of psychiatric disturbances:

Anxiety, aggressive behavior, paranoid ideation, posttraumatic stress disorder, depressive disorders, increased suicidal risks, poor self esteem, depression, dissociative disorders, substance abuse (alcohol, drugs), violent behavior/outbursts

The longer the abuse, the more scarred they are in life. The more traumatic the abuse, the more psychiatrically imbalanced these children become. Sometimes, they assume a complex that is similar to the abuser and in turn abuse other children or siblings.

I had a walk-in patient a couple of years ago. A mother had her youngest 4 year old son with her. I was not her regular pediatrician. I asked her why she brought the boy over. She was initially hesitant but then after a few minutes had told me that I was referred by a patient of mine. She wanted to know how to examine for sexual abuse. I asked her who was abused?

She looked at her 4 year old son.

The other day she had come home early from work and caught her 7 year old son forcing the 4 year old boy to give fellatio. She was shocked and confronted the 7 year old. The reply caught her by surprise.

"Is it wrong mom?"

"Of course it is!! Why would you do such a thing to your younger brother?"

"Mom, daddy and grandpa do it me and they said that it was alright."

I was the one that got shocked.

I asked her to provide me a background on the family in order to understand what was going on. The husband was 5 years younger than her and that the father of her husband had lived with them. Both the husband and her father-in-law were very close. Strangely close in fact that at times she would wonder why they hugged each other in intimate ways. When I asked her to elaborate, she just shrugged me off.

I performed a full physical examination on the 4 year old while she went on telling the story of her family. Her husband stayed home after he lost his job 2 years ago. Income comes from both her and her father-in-law. The husband had a history of drug use and abuse, but she swore he was clean now.

At first she found it odd that her 7 year old would wake up in the middle of the night crying and screaming, but the husband would tend to him because she was tired from work. After a few minutes the crying would stop. This went on for awhile but came to a halt.

The 7 year old was a bright student during his kindergarten and during grade 1. But the last year, his grades seemed to deteriorate and when she asked him why he had lost interest in school, the father took over and said that he would take care of it.

The initial physical examination was normal and showed no external sign of abuse on the 4 year old. I encouraged her to tell the authorities this but she refused. I talked to her about counseling for the father and that I thought that the intimacy of the grandfather towards the father had somehow inculcated in her husband a sense of being right when it came to molesting their own children. That this incestuous behavior was unacceptable and that pedophilia is a psychiatric illness.

She thanked me and simply replied that they were all that she had in her life and that she would think about what I said.

I never saw her again. And I wonder what ever happened to them.

I blog about this today because I was faced with another patient the other day. The parents of a patient had brought in their 6 year old son for his usual immunization. He was combatant and as in immunization days, refused to get his shot. He would scream and struggle. I was startled because the father picked up the boy, hit him on the face, slapped his head and then held him down. I gave the shot and when it was over the boy just ran out of the clinic. I asked the parents to sit down and wanted to discuss corporal punishment with them.

I asked them if they hit the boy a lot and the mother looked at her husband. The father said that it was what the boy deserved.

"Nobody deserves getting hit. And most especially not in front of other people."

The father replied "my parents used to hit me a lot, so what's wrong with hitting my son?"

"Self-esteem that is developing at this age is all he's got. He is mature enough to understand explanations. You can sit down with him and try to explain why he needs to get his shot or why he needs to get punished. But the more you hit him, the more he hits back in the most unusual ways. There is a way to make the boy understand the consequences of his actions, but not in a physical way. The trauma that you instill will always be remembered and it will remain ingrained in him the rest of his life."

I stepped out of the clinic and saw the boy slumped in a corner and asked him if he was fine. He nodded and said that he didn't like shots. I explained to him why he needed it but I guess he already knew that I was simply trying to pacify things. He had a look in his eyes that gazed far far away.

As pediatricians, we miss the tell tale signs of family abuse. Parents bring their kids to us not only for the regular shots or an antibiotic when the child is sick.

We need to learn to recognize signs of child abuse in the family setting. Children are not born defiant from the get go. They do not go burning buildings or stealing things at an early age. Something in their family triggers the event.

It is not normal for children to hit other children or bully their own siblings.

It is not normal for children to cheat and steal.

It is not normal for children to take alcohol at an early age just because the platoon of friends says so.

It is not normal for your daughter to sneak out in the middle of the night and have sex with her boyfriend.

it is not normal for children who have done well in school to be suddenly underachievers.

It is not normal for children to binge on food or have bulimia.

It is not normal for the father to be bathing with his 10 year old in the nude and rubbing his body against his.

And when we let it go even when we recognize it, we become accomplices to the creation of a sociopath. They remain scarred for life and society pays for what it gives.

Payback is such a bitch!

[Photo from fotosearch.com]