It's a Filipino thing...From Coffins to Vacations

You get all the jokes about traits that make one a Filipino.

There was the story of a Filipina nurse who had just found work in the United States. She (and her relatives) were so happy of this news. She had 20 or so relatives who depended on her for either dole outs or some financial assistance. She traveled with her mother to America on what would be the last hurrah of her savings. But even before she could start settling down, her mother had passed away. Because it would be too expensive for her to travel back with her mother for the wake and burial, she had sent her mom in a wooden coffin back to the Philippines.

When the coffin arrives in Manila, and the relatives open it, they are aghast at what they see. The old woman has her face plastered against the glass of the coffin. There was an accompanying letter that read:

DEAR KUYA TONIO, ATE LETY, KUYA JERRY, ATE GRACE, LOLO, LOLA, JUNJUN, JEKJEK, MAIMAI, ANNANN, RICRIC, LETLET, KATKAT, TOTI, TITA RINA, TITO BOY, AT SA MGA PINSAN KO NA DI KO NAKIKITA PERO NAGHATID SA AMIN NI NANAY PAPUNTA SA AMERICA. PASENSIYA NA KAYO AT DI NA AKO SUMAMA KAY NANAY PAUWI. MASAKIT MAN SA AKIN, SIYA NA LANG ANG PINAUWI KO. ALAM NIYO NAMAN NA MAHIRAP ANG BUHAY NGAYON AT KAKASIMULA KO PA LAMANG.

PAGBUKAS NINYO NG KABAONG PAKIKUHA ANG 50 LATA NG SPAM SA MAY ILALIM NG UNAN NIYA. MEDYO MUKHANG TUMABA SI NANAY, PAKI HUBAD NA LAMANG ANG MGA DAMIT NIYA. YUNG MGA 6 NA JERSEY NG NBA AY PARA SA MGA PAMANGKIN KO. LARGE AT EXTRA LARGE SILA. HUBARIN MO NA RIN ANG 5 BRA NA SUOT NI NANAY AT PARA KINA ATE AT LOLA YUN. YUNG 4 NA MEDYAS NA SUOT NI INANG, PARA KAY LOLO NAMAN. MAY PANTIES AKO PARA SA MGA PINSAN. SUOT DIN NI NANAY, PAKITANGGAL NA LANG. MAKIKITA NINYO NA NAKA NIKE SIZE 15 SA PAA NI NANAY - PARA SA IYO YAN KUYA TONIO. YUNG 8 RELO SA KALIWANG KAMAY NI NANAY AY PARA KINA ATE AT BABAE KONG PAMANGKIN, TITA AT LOLA. YUNG 8 RELO SA KANANG KAMAY NI NANAY AY PARA KINA KUYA AT LALAKE KONG PAMANGKIN, TITO AT LOLO. SA MAY PUWETAN NI NANAY AY MERON MGA COMFORTERS PARA SA INYO. SA ILALIM NG KABAONG NIYA AY MAKIKITA NINYO ANG MGA SHAMPOO, CONDITIONER, KIRKLAND VITAMINS AT FISH OIL, PEANUT BUTTER, IBA'T IBANG CHOCOLATES, POTATO CHIPS AT DE LATA. MERON DIN DIYAN YUNG MGA BAG AT T-SHIRT NA GAP NA BINILI KO SA OUTLET. BAHALA NA KAYO MAMAHAGI SA MGA KAMAG ANAK AT KAPIT BAHAY NATIN. OO NGA PALA, YUNG KUWINTAS NA SUOT NI NANAY AY PARA KAY ATE LETY, YUNG MGA HIKAW AY PARA SA MGA PAMANGKIN KO. PINADAGDAG KO NA LAMANG SA NAG EMBALSA KAY NANAY NG 5 BUTAS PA SA MAGKABILANG TENGA PARA MAGKASYA YANG MGA HIKAW NA FANCY. ANG PINAKAHULI AY SA MAY PUWET NI NANAY MERON KAYONG MAKIKITANG IBA'T IBANG URI NG PABANGO. ANG MGA JOVAN MUSK AY PARA SA MGA LALAKE. ANG CACHAREL AY PARA SA MGA BABAE.

SIGE. MAHABA NA ITONG SULAT KO. AT NAPAGOD NA RIN AKO SA PAGIYAK AT PAGAYOS NG BANGKAY NI NANAY PAUWI DIYAN. PAGPASENSIYAHAN NA NINYO ANG MUNTI KONG PASALUBONG

NAGMAMAHAL,

INDAY

P.S. PAGHUBAD NINYO KAY NANAY, PAKI AYOS LANG NG ITSURA NIYA BAGO ILIBING.



Where does the story lead?

It's supposed to be the story of every Juan in us. I'm not sure if it depicts how spendthrift the Pinoy is or how misplaced our sense of spending is. On our vacation in London, I was telling my partner that I was observing the Filipinos wherever we went. There weren't many Pinoys in the galleries or the museums (come to think of it there were none during the days we were there). There was a Pinoy couple who went to one of the plays (The Elephant Man) on the night we were there. However, when we went to the Harry Potter Studio tour, we spotted several Pinoys in the crowd. When we had lunch, there was a family of Pinoys who sat next to us. The father opened his bag and voila - handmade sandwiches, fresh strawberries, bottles of water and soda, chicken wings and sausages!! I had this smile to my face. And they definitely had a more delicious lunch compared to the paltry tasting overpriced theme park food. They knew how to conserve their cash because they definitely were not poor. Mom was carrying an LV bag and the other children were lugging bags of various designers. And the boys were in spanking new Adidas sneakers. So you've got to give it to how thrifty the Pinoy can be. You will not see them dining in fancy restaurants or having breakfast in the hotels (unless it's free). They're having a happy meal at the next McDonalds. You won't see them having afternoon tea at Laduree. They're at the next Starbucks sharing a grande with the family.

The highlight of every vacation is having to enjoy it. Whether it's a luxurious one, or one on a budget - it's the company that counts. It's the memories that you take back with you that matters. It's the stories of love, life and happiness that we reminisce and capture in pictures that remind us of pausing our frenetic lives in this rat-race world and enjoy some of the hard earned money we reap to recharge our weary souls.

It's the journey that tell our stories...

It's been awhile...

This year's annual leave from work takes a twist on the old and the changes in the new.

First is the fact that after a respite from NAIA terminal 1 which is currently being renovated, I am back. And am pleasantly surprised that some renovation is coming along. I guess I expected to be "amazed" or probably have eyes wide open at "changes" at the NAIA 1, but the disappointment tugs in my gut.

It's obvious that I can't help but compare (aren't we all entitled to compare?) the renovations at NAIA 1 and my first airport stop at Hamad International Airport in DOHA, Qatar.

Like two friends during my travels, both NAIA 1 and Hamad International are places I have not been to for quite some time. Both are undergoing renovations as well. I guess it's not going to be a fair comparison because obviously our paltry-looking NAIA 1 will pale in comparison to the opulence of Hamad International. The economies between the two countries are, after all, far apart from one another.

NAIA 1 isn't completely done yet, and while the lighting looks brighter, the makeover is shabby at best. Of course, the only positive thing here is the choice of food stalls. The fact that you have Starbucks inside NAIA 1 tells you that at least there will be decent food in the area. The business class lounges are a sore eye. Old, lacking in quality and refurbishment, warm (air conditioners are barely functioning), and entertainment a clear blur (TV is really hazy) - the lounges are a reflection of how third world we are...and sadly, will remain this way until the government gets its act together. I deliberately did not take pictures anymore, as taking a photo of the lounge would have been insulting to my camera phone. Oh yeah, I don't need to mention about the customs counter. While there seems to be a semblance of service, nothing much has changed. And there's really no surprise there.

Landing in Hamad International Airport opens up to a totally different ambience. The duty free shops and lounges and food kiosks are carefully segregated. Once upon a time, we landed in the Mujabi desert and had to be scooted out of the plane to the airport using busses (or as first class passengers, on a BMW) in the hot summer air! Today, there are no bus gates. Just tube connections to the vibrantly spankingly clean airport. The business class lounge is an oasis of tranquility and world class service.

As a Filipino, I can't help but wonder why we cannot seem to try to improve on even the bare essentials like providing a decent looking gateway to tourism for the world to see! We throw billions of pesos into needless spending and graft and corruption, or even bonuses for the people running government-owned corporations, have megamalls and shopping venues that are jaw dropping...I can't understand why we cannot even spruce up a dilapidated airport.

It's really been awhile that I've seen changes in our own country. And our politicians aren't really good at taking criticisms well. To them, it's really just excuse after excuse after excuse. For lack of a better description on our politicians, it's really been awhile, since we've had someone willing to die for the country, to literally make a change.

Tips to remember when traveling to Seoul, Korea

As of this writing, I'm holed up in my hotel (the Ibis Ambassador Myeongdong) trying to recall what are the most important tourist trips when traveling to Seoul, South Korea. In case I forget, or am inaccurate, feel free to comment.

During our trip to Seoul, we never took the subway for the very reason that I was traveling with my partially disabled 78 year old mom who really wanted to see some Cherry Blossoms in her lifetime. Hence, the extraordinary preparations on this travel.

1. I told my travel agent gazillion times that I was traveling with a partially disabled senior citizen. Make sure that the wheelchairs are in place. That's where you see the very very wide discrepancy between the Philippines and South Korea, not only in the service of the airline but the airport as well. We took our flag carrier Philippine Airlines (PAL). The heat was horrible. NAIA 2 was sweltering hot and all those giant fans did nothing to cool the aging airport that is home to PAL alone! And the wheelchair (and the guy supposed to push the wheelchair) was nowhere in sight. The Holy Week exodus is NO excuse for the nonfunctioning air conditioners, nor for the sloppy service in assisting elderlies and the disabled, or being such a paltry lousy airline altogether. When we arrived at Incheon Airport, the wheelchair for my mom was ready and the guy who was handling her was so efficient and caring that you'd even wonder why the Philippines even attempts to compete with the tourism industry. The itsy bitsy teenie weenie airport in Manila that's cramped like a sardine can has little to boast to the rest of the world in terms of being an airport showcase. The least it can do is make it more comfortable instead of adding insult to injury.

TIP TO REMEMBER: Even for the difference in bucks, take Korean Air or Asiana. At least the airline service will compensate for the lousy airport in the Philippines. Besides, the time schedule of Korean Air and Asiana Airlines are much better than PAL or Cebu Pacific.


2. Bus, cab or private transfers? Because the weather was still between 6-15 degrees centigrade in Seoul when we left Manila, I made sure that we had private transfers so that my mom would not have to bear the cold and have to walk too far. The limousine bus 6015 from Incheon Airport to our hotel was a direct one. It would only cost you 10,000 Won (around P400.00). Taxi is dirt cheap in Seoul. If you're four people traveling (or five to six using a Jumbo Taxi), you can split the bill of 60,000 won (around P2400.00) by cab. Private transfers were too pricey at $250 each way (or P12,000). I will have my travel agent shot tomorrow for not foreseeing this.

TIP TO REMEMBER: Never trust your travel agent. Do a more thorough research. Better yet, make a Korean friend and ask him/her the best way to travel around Seoul or any part of S. Korea for that matter. If you're traveling in groups, the taxis are more cost-efficient and faster than taking the subway.

3. Now that we've settled into the cab mode, here's the third most important tip - never trust a cab driver that he knows directions even if the concierge in your hotel writes it down in Korean or that he has a GPS inside his cab. Chances are, you'll get lost with some of them who are either unfamiliar with most of the places around Seoul or just want to earn a few more bucks from you because of the cheap cab fare in this country.

TIP TO REMEMBER: Always remember the nearest subway station of your destination. That way, in case your cab driver gets "lost" and you need to obviate the language barrier (they don't speak or understand English at all!!!), you can always mention the subway station. Now that's a common language for them.

4. It's always great to be spontaneous and sometimes some of us like having an itinerary so we book a tour ahead of time. Unless you can get a private tour (which will cost you around $600-$1000 depending on whether you want lunch included or not), it's always good to go on a city tour so you can get acquainted with the history and landmarks in Seoul. And while there are many places to go and culture to learn and fun spots to see, some of them are really not that great.

TIP TO REMEMBER: If you had little time to explore Seoul, the best adventure would be the night market on Nandaemum and Myeongdong. You can literally just pig off the food on the streets with the street hawkers. However, beware because some of them remove the prices when they see an abundance of tourists. Usually the prices of the food are similar to one another. The food trip is so worth it! You just need to avoid too many palaces. One palace is enough. The Blue House (where the Korean President resides) isn't that fabulous. You can skip that one too. Namsam Seoul Tower is a nice spot to visit. It's not necessary to go up higher when you're inside the tower. Lotte World Adventure Park is old and gray and expensive (almost $38.00 per person) and they won't allow you reentrance when you exit because they usually offer the one day special pass for tourists. Most of the rides in the park are closed and some (especially the indoor park) will require additional payment (on top of the entrance fee) so you can play or experience some cool stuff. Seriously, it's a waste of money. The cartoon characters are ugly and I've never even heard of them. Oh, the good part about Lotte World Park is that there's a shopping mall beside the adventure park. The park is not disabled friendly, although they do rent out wheelchairs. Shopping and food tripping are the highlights of Seoul.

5. Of course we've come to the best tip. Eating out! Korean food is probably one of the best in the world (I love Japanese food more). With that said, Kimchi is their national staple and every meal is as spicy as the Spice Girls. There's some fusion Korean food but they've tried to make their meals as authentically Korean as possible. Because you and I most probably don't read or write or speak Korean and many of the Koreans do not seem to understand English clearly, it would be best to look for a few telltale signs we can find useful.

TIP TO REMEMBER: Always ask for an English menu - just to let them know you're a tourist, you can't read or write or speak Korean. If there's none, use a menu that has pictures and point to the picture of the food you want to order. If you're still unlucky, and you're starving already, look at the next neighbor and find out if what he's having is good or great and ask the waiter to just get you what the guy seated next to you is eating. When still in doubt on how good the restaurant is - look for a sign that says GOOD RESTAURANT. The latter is given by the government to assist tourists who like to play ala Michelin! And if you're still in doubt on the food - remember - you'll never go wrong with Korean Fried Chicken (or Roasted Chicken).

The next blog will center on our vacation to Korea with my small caboodle family.

Happy Easter to everyone in advance!

"Stupid is Forever"

"Stupid is Forever"
- Miriam Defensor-Santiago

This was an early morning headline. Some idiot working in the government had an epiphany. I guess their administrator Hans Cacdac needed a pathetic excuse for the government employees at the POEA (Philippine Overseas Employment Administration) to be on Facebook 24/7. The agency is reported to "require the use of Facebook to establish a communication platform for domestic workers, recruitment agencies and the government." In addition, it "has also required all recruitment agencies to have their Facebook accounts and share these with domestic workers they deployed."

As the news reports it verbatim:

“The account can also be used to prevent dispute between household service workers and their employers, or the worker can endorse their complaint to the POEA and recruitment agencies through the FB account,” POEA chief Hans Cacdac said.

“The creation and maintenance of Facebook account will also be required for the processing of the household service workers and the POEA will also monitor the agencies’ compliance through their account,” he added.

I'm not really sure of this idea - but I believe it takes two to tango. If I were the employer, I would definitely ban the household help from accessing any FB account during work hours. And while they are free to go around posting on FB their musings for the day, I expect them to work when they need to. And when they're out of the country, say, working as household help in some more industrialized country, whose internet connection or computer work station will they use? I'm not quite sure if this was well thought of or whether there was any spark of brilliance on the RULE that Cacdac wants implemented.

So here's the question - if I'm the employer and I don't want to abide the rule of POEA in mandating a FB account and access to Filipino workers - what will the Philippine government do about this? Who stands to economically lose from this lame brain idea? Even on the issue of addressing disputes between household service workers and employers, I have my deepest doubts on how the POEA thinks it will even help endorse a complaint to the agency. If such a complaint is filed, will the POEA find field agents to extract them from the employed territory?

The traffic has been horrible the last few months. With the monstrous road repairs and the MRT trains & rails requiring the long needed maintenance, Metro Manila is really not a happy place to be in.

I have lived in the South of the metropolis for almost four decades. That was when moving from Alabang to UST was just a 35 mins drive! Today, it's a 2 hour crawl if you leave after 630AM to reach the university. And it's not just the cars or public vehicles on the roads. While there's a clamor to improve the public transportation system - we've not addressed properly the question on, HOW DO WE DO THIS? It's obvious that adding more buses isn't the answer. Neither is urban planning. It's too late for Metro Manila unless you want to pummel all the landmark SM malls from North to South to East to West of the metro. Or that adding more railways above ground isn't the way to go. And that we'd probably be all dead before we see hope for any subway service. And those jeeps and tricycles need to really retire. And those vendors who occupy the sidewalks need to disappear. And we need to address the problem of jaywalking as well.

The Philippines has this obsession of building anything ABOVE the ground. That includes the pedestrian crossings called overpass. This is done so that (A) it does not disrupt traffic on the ground and/or (B) so that there is a source of corruption with governmental projects. I firmly believe that it's the latter. It's a useless prop because these overpasses are not well utilized (as they are full of vendors or thieves) and that the Filipino culture is playing "patintero" with oncoming vehicles.

If a law was passed that it would REWARD anyone who runs over a jaywalking pedestrian, I don't think we'd get idiots crossing the streets.

The other day, I was crossing a pedestrian lane somewhere in Makati and there were jaywalkers who were running across the street a stone's throw from where I was standing. There was a MAPSA officer in front of us. He was busy texting on his mobile phone. After a few minutes observing him, he was chasing a car with a number-coded plate number. He just turned a blind eye to jaywalkers.

It's not only in Makati though. I have yet to see Traffic Czar and MMDA honcho Francis Tolentino instill this policy along C5 and the whole of EDSA where the commuters make a dash for it across the streets for the finish line. And these pedestrians make a mockery of the law and we just sit back and watch until some idiot gets into a fatal accident!

With all that's been going on among our lawmakers and people employed in government, there needs to be a stricter implementation by the Civil Service Commission on the requirements of individuals to hold public office. They all need an IQ test. At the rate some of these government officials are going, it looks like an IQ of <60 has become a mandatory requirement to be fit for a government position.

Towards the last quarter of last year, Party list congressman and former mayor of Manila Lito (two-face) Atienza was one of the proponents asking congress to pass a bill exempting boxing king and forever absent Pacquiao from having to pay taxes for his winnings (and losings) to the BIR. I get it - Pacman has a sob story and is a rags to riches inspiration. So do other athletes and professionals who try to make a decent living and yet PAY the government the tax due them.

Let's call a spade a spade. If Pacquiao really had the documents to show regarding his payment of taxes in the United States, I don't think the local authorities would still be running after him. He has a whole battery of lawyers and people whom he can pay to do the paper works. It's just not there. End of story.

Now what the fuck are the idiots in congress and now joined in the Senate by another idiot proposing?

Effing stupid! I don't know what flashed through the night when Koko Pimentel suddenly thought of having this kind of resolution even passed. I tell myself that it may have been an orgasm that had gone bad? But it's outright double jeopardy to the Filipino people because (1) EVERYONE pays the taxes due them (otherwise change the goddamn Taxation Law first), and (2) CONGRESSMAN Manny Pacquiao has stolen from the coffers of the Filipino people because he has been absent from Day 1!!! I don't even know why these absent politicians don't get booted out of office!

Then there's the wedding of the year...or so they say...

The tongues in the social circles were wagging that Chiz and Heart were "pissed" that the wedding of the year should have been originally held on the 14th of February and not on the 15th as the actual date. Well, a chinese couple had already reserved Balesin on the 14th so the fairy tale wedding had to take place the next day.

But Chiz and Heart are no Dingdong or Yanyan. If we were to believe his SALN, Chiz is the second poorest senator at a little over P8M ($177,777) for his assets, liabilities and net worth (with only P3M cash on hand). In short, he's not the kind that could afford a 2 carat diamond ring, a Monique Lhuillier gown for his bride, a wedding in the members only Balesin Island, and a second reception for friends of the bride and groom at the Blue Leaf to over 1,000 guests!!!

Of course, while he's part of the circle of PNoys friends, he probably won't get investigated by Kimmy but there's a legitimate question that's requiring not only an investigation but an answer as well - HOW CAN THE 2ND POOREST SENATOR PULL OFF A WEDDING THAT IS BEYOND HIS SALN?

Seniang and our Amazing Race to Paradise

As early as April 2014, I had already booked our New Year holiday for the close of 2014. Our destination - BORACAY!!

It's been over a decade since the kids (who are now all grown up), my sister and mom have been back to the island. The anticipation over this vacation was made stressful by our head on collision with mother nature - Typhoon Seniang - who decided to douse rain over the fireworks of the Filipinos in welcoming the New Year.

With a 77 year old senior citizen in tow, I really didn't expect an Amazing Race escapade.

Our flight out of Manila to Caticlan on December 30, 2014 was scheduled at 9AM. Typhoon Seniang was already bearing down her fury in the Visayas that day. When we arrived at the airport at 730AM, our nail-biting journey had begun. At 9AM we were at the boarding area. The two earlier flights to Caticlan had left Manila. That was good news. Our flight was up next. There was no announcement at 9AM...then 930AM...then at 10AM they announced that there was a delay in our flight because of the weather disturbance. Patience became a test of strength. My mom was finishing the second round of her rosary. At 1045AM, the announcement came that boarding for Caticlan was in progress. FINALLY!!!

The plane had departed Manila at 1135AM. At around 1210PM we were about 5 miles from the Caticlan airport...and the pilot announced that we were going for another spin as the airport was not visible. My mom was on her fourth round of her rosary. As the pilot made another attempt to land, he announced that the rain in the island was making the landing a challenge...so we were going another round...then you could hear the flaps roar, the wheels come down and the pilot announcing to all that we were making a landing attempt. The landing went smooth but with the wet strip, the plane came to a halt almost at the tip of the strip.

And it was rainy and windy. I found out later that we were the last flight out of Manila into Caticlan.

On arrival in Caticlan, Vance from THE DISTRICT BORACAY (www.thedistrictboracay.com), had umbrellas in tow and the van was ready!

The second challenge was moving from the port to the next port - via a motorized banca. The water looked angry and choppy. All speed boats were cancelled. After an hour of waiting at the port, the banca was ready and we took the 15 minutes see-saw nauseating trip from Caticlan to Boracay. If there is one thing I can say about Vance is his "never say die" attitude. Amusingly - our family was like one troop of Kamikaze warriors off to battle, including my 77 year old mother who didn't let up in spite of the raging typhoon.

The DISTRICT BORACAY was a great find in the heart of Boracay. It is a boutique hotel right in the middle of Station 2. From the beach, you will find D'Mall a few steps to the right and more restaurants (Starbucks, Army Navy, Pamana Restaurant...and more) to your left. The hotel is beautiful. The rooms are large. The linen and amenities are first class and clearly well thought of by the hotel. They don't scrimp on luxury. What's more, they don't scrimp on service! If there's one thing that stuck clearly on my mind was the outstanding, five star service this hotel brings. There are no words to describe the great Filipino hospitality that shone through in every personnel in the hotel. From the driver of the van to the front desk crew to the security guards on the beach...everyone made the difference between staying in a hotel or staying in heaven.

The breakfast buffet in the hotel was superb (one of the best I've had) and if you woke up kinda late after a late night out or just felt too lazy to get out of the uber comfy beds of The District, you could march into the Star Caruso Lounge and have brunch up to 1230pm for just a little top up.

My full review of the District is on Trip Advisor.

The four days, three nights New Year vacation was made more memorable not only by Typhoon Seniang who drenched the island with rain on New Year's Eve but rather, the count down fireworks show on the black shores of Boracay during New Year's Eve was by far the best firework performance I have seen so far.

What was there to do in Boracay for four days and three nights?

Relax. Eat. Sleep. - #RealVacation

The storm had passed on the day we left, but the kinks stayed behind. On our way back to Manila, our 330PM flight was delayed. We were then offered by Philippine Airlines P3,000 EACH, if we gave up our Caticlan seats in exchange for a flight out of Aklan at 7PM. A tempting offer but we passed on it. All the remaining afternoon flights were then cancelled. EXCEPT for the 330PM flight!! Which was delayed. And when the plane arrived at 5PM, we were hurriedly boarded into the plane in order to catch up with the sunset curfew. (Because there are no lights on the runway of Caticlan, there are no evening flights. The last flight is when the sun sets.)

It was a vacation that would be remembered forever.

Who said that only the Pope would be racing with the storm? With my 77 year old mom in tow, it can truly be said that every vacation - IS TRULY MORE FUN IN THE PHILIPPINES!

Ethics of politics in health care

The last few months, since the leave of Health Secretary Enrique Ona from the Department of Health, the health department has received several flaks from certain parties with vested interest and conflicts of interest on the matter.

I do not personally know the health secretary. However, the allegations being thrown at him, from no less than the President of the Republic of the Philippines himself has left me wondering why there is so much ire against him by no less than the person who appointed him to that position?

So far, the president has defended all his appointees, especially the favored ones. From PNP Chief Purisima who has been accused of falsifying his SALNs to Sec. Butch Abad who has been shaving the PDAF in favor of the DAP to DOTC Secretary Abaya who has been accused of running the MRT projects and bids as a family affair...strangely, it is the health secretary who has been in the news lately on controversies after controversies.

While I may not agree at certain issues with the health secretary, there are, however, public health issues that are valid decisions made on behalf of the public.


Vaccines and Public Health

Is the PCV 13 really superior to PCV 10?

There has never been a published study on a head-to-head long term study on the efficacy of preventing pneumonia, otitis media and invasive pneumococcal disease between the two vaccines.

The pneumococcal conjugate vaccine is designed to protect against the serotypes in the vaccine. For example, PCV 10 should cover against the 10 serotypes with additional cross protection against one or two other serotypes. PCV 13 should cover against 13 serotypes. Both vaccines DO NOT guarantee 100% efficacy. Improved vaccine efficacy end-points are based on the completion of all doses administered and NOT JUST ONE DOSE.

The Philippine Daily Inquirer reported that Dr. Issa Alejandria, an infectious disease specialist and epidemiologist at the UP-PGH said that PCV 13 averted more cases of pneumonia, otitis media, and invasive pneumococcal disease during a health forum in Quezon City. I am not sure whether the reporters just got confused or that the message Dr. Alejandria delivered may not have been completely accurate. But let me get that clear. There is NO WAY you can tell exactly how many cases of pneumococcal illness was averted by providing either of the vaccines. The data can only provide a mathematical approximation of "what ifs" based on the serotypes that are covered by each of the vaccine.

Clearly, there are issues that were blown out of proportion.

First. Did the World Health Organization actually file a complaint on which vaccine was to be used? NO. The utilization of which vaccine to recommend lies on each agency and each country based on local epidemiology. Both vaccines are WHO Prequalified.


Second. If you look at the vaccines being given at the health centers, or even by the Department of Health, many, are actually different from what is being given in private clinics. The DTwP or whole cell pertussis version is still being given in the community setting in spite of the fact that it is noted to be more reactogenic (higher side effects). Why? Not because it is not better. Studies now show that the wP version may actually be more effective (although more reactogenic), but a lot cheaper than the DTaP or acellular pertussis version.

As a concrete example, in selected areas where the rotavirus vaccine is being given for free, the monovalent rotavirus vaccine is the one that is being administered in spite of the fact that it covers only the G1P8 strains. Local epidemiological data from studies out of the Research Institute for Tropical Medicine have shown that the circulating strains may vary from year to year. For the Philippines, more than 70% of the circulating strains in the past three years have been G2 and G3 with less than 10% attributable to G1P8. Why was a monovalent vaccine selected over a pentavalent vaccine when the latter is also available in the Philippines? Because of cost issues.

And I can go on and on about the vaccines available in from the government compared to the ones being administered in the clinics, but this is beyond the scope of my blog.

Public health programs are designed to address a more comprehensive health coverage in spite of limited financial resources. The decision to use either the PCV 10 or 13 should be based on economics. Given the fact that there are more than 15 Million children less than 5 years old in this country, the 560,000 doses of the PCV 10 that was bought (vs. 520,000 doses if PCV 13 was purchased) was not even enough to AVERT anything. Each child will need 4 doses of the vaccine. Which means that with PCV 10, only 140,000 children would receive full immunization (or 130,000 children had PCV 13 been used). 10,000 children receiving PCV vaccine is much higher than the mathematically derived "averted" numbers.

A study published in Vaccine [Vol 30 Issue 11 on March 2, 2012, pp. 1936-1943] by Castañeda-Orjuela et. al. showed that using a Markov model, the authors evaluated the cost-effectiveness of three PCV vaccines - 7, 10 and 13. While PCV 13 may have increased the expectancy of LGY (life-gained years), the ICERs (Incremental cost-effectiveness ratios) of PCV 13 was above the per capita Gross Domestic Product. The study concluded that while PCV 13 would prevent more diseases and deaths with higher LGY, PCV 10 would save more cost to the healthcare system due to its higher impact in the prevention of Acute Otitis Media.

In the Philippines alone, data from the RITM on the Antimicrobial Resistance Surveillance Program in 2013 showed that of the 25 isolates for invasive pneumococcal disease, the most common were serotypes 1 and 5. The other serotypes reported were: 2, 14, 23, 18, 3, 4, 6, 19, 20, 32, 33, and 34.

PCV 10 covers against serotypes 1, 4, 5, 6B, 7F, 9V, 14, 18C, 19F and 23F.
PCV 13 covers against serotypes 1, 3, 4, 5, 6A, 6B, 7F, 9V, 14, 18C, 19A, 19F, and 23F.

Both vaccines did not cover against serotypes 20, 32, 33, and 34.

The only reported case of serotype 3 in 2013 was in an adult patient in the 20-64 years old bracket.


Which goes to the third point. The immunization program of the government covers only children and DOES NOT include adults.

As to what the president was ranting and panting in his press statements regarding this issue, smells of politics reeling its ugly head.



Cure for Dengue

I had patients that were asking me about the latest "cure" for dengue. This is the drug called ActRX TRIACT being marketed by the son of former senator Heherson Alvarez. The drug, a mixture of artemisinin-artesunate-berberin is claimed to be a breakthrough drug developed supposedly by ActRX Operational Group. Ltd. with its office out of Clark Freeport Zone, Pampanga.

As a pharmacologist, I have to put my foot down on this issue. I do not know why this clinical trial was even given a green light by the DOH. In the first place, artemisinin-artesunate are one of the most effective first line drugs in the treatment of P. falciparum malaria. Making it available for "dengue" is dangerous because the Philippines is endemic for malaria as well. Inadvertent use for every clinical symptom that smells like or looks like "dengue" can be catastrophic at the global control of malaria.

We need to remember that one has a cure (malaria), the other DOES NOT (dengue). Dengue is a self-limited disease and like many viruses, the key to addressing the problem is looking for the right vaccine. In addition, appropriate maintenance of a cleaner environment will address the outbreaks we see. Unfortunately, the present environmental and living conditions of the Filipinos will always remain a problem unless government steps in to alleviate the plight of the poorer sectors of society.

The premature approval and the marketing claims of the company that sells this is unfounded and unethical. It is but right that the clinical trials be stopped until more evidence can be shown that the use of the antimalarial drug artemisinin-artesunate has a role in the treatment of Dengue.


When someone asked me what my thoughts were of the current storm the health department is facing, I simply said that it was political.

I don't know what other baggage the administration will throw Ona's way, but please spare the public. All this political mileage is pushing the health of the public into limbo.

The worst kind of politics is to involve the continued delivery of health care to the people. What you see now is similar to PNoy approving the conduct of a badly designed clinical trial, short of calling it unethical, only because there is a pawn that can be played and that outcomes are only for the good of political alliances. Never mind the health care of the public. After all, for the longest time, the annual health budget is one of the lowest in the world. And the people do not consider health as a priority.

Noted author Laurie Garrett puts it best in perspective when she says "What public health really is is a trust. That's why I used the term 'Betrayal of Trust' as the title of my book. It's a trust between the government and the people".

Three

I did not get the chance to say goodbye.

On September 16, 2014, I formally stepped aside from being Chair of the Department of Pediatrics at Asian Hospital and Medical Center, a position I accepted three years ago.

In 2011, when I assumed the position to lead a department at the hospital, my initial reaction was fear. I don't know how many of my colleagues knew that, but now I can confess to you my skepticism in accepting the role. I was afraid. Because I barely knew 30% of you. Because I did not know how you would accept me. Because I did not want to let you down on expectations.

The first few nights were practically sleepless ones for me. I would call or drag Bettina to one side and ask her who all the pediatricians at the hospital were. We would go through your names one by one and I would need to place a face in the name. While many of you knew me because you either were once my students or had heard me give a lecture in some conference or convention, I needed to get to know you better. I would ponder and dream of great things for our department. After all, pediatrics is not a major contributor to the financial coffers with "toys for the big boys" like surgery or "dramatic landscapes and stories" like oncology or "sculpting and laser technologies for the forever young" like dermatology. You get kids - either sick or the newborn. They come in for a couple of days. We fix their disease. They go home. No fanfare there.

Where do we put our mark in this hospital?

Three years ago seemed such a long time. On our first staff meeting, I laid out my plans and asked your support. I believe you were all overwhelmed.

Residency training.

Mother-baby friendly hospital.

Pediatrics office.

Continuing medical education courses.


Was I dreaming or was I crazy? Is he nuts? Did we just elect the wrong person to lead us? My God we're going to actually work?!?!

I needed to prove to you that together, no dream would be too small to achieve.

The three years went by very quickly.

Somewhere along the road, someone decided that JCI Accreditation would be part of the picture. That wasn't in our road map initially. But together, we took it in stride. Even if I had to stand at the podium for the next 9 straight hours giving the lecture, by golly I did and my God, you all stayed behind to finish it!

We had our official accreditations for life support programs and when push came to shove, the remaining few that were not board certified really proved to themselves (and to me), that, yes, they could do it. Taking the amnesty certification exam was no small task and I take my hats off to all who took it and congratulate those who made it. It was a pat on your back that you truly deserved. I just provided the push, but you made yourselves proud.

The back-to-back annual continuing medical education activities were tremendously successful. We raised enough funds to contribute to the continuing education and training of our own residents as well.

The mother-baby-friendly hospital was a challenge because it would mean the cooperation of the department of Obstetrics and the hospital administration. We had a few disappointments from moms posting on FB their rules of engagement for being breastfeeding advocates, but we stuck our guns and still bagged being accredited MBFH and being the only hospital that's accredited being mother-baby friendly in the workplace too!!!

And of course my pet project, the pediatric residency program. During our first try at it, we were gently struck down by the Philippine Pediatric Society because we lacked a few requirements. Getting residency training accreditation was more difficult than JCIA. I needed to show you how determined I was at getting Asian Hospital accredited. I went home that day and cried my heart out, but I didn't want to show you my weak side. Of course I cry! I also bleed. The second try last August 2014 was nerve-wracking. There were questions that Drs. Mon Arcadio and Gener Becina would ask on the side, and I had no answers, but reassured them that I would be here always to make sure that we graduate our first trainees and make home grown pediatricians out of them.

I was in the middle of seeing patients, when Gener and Mon (and Madz) texted me last September 10 that the PPS Hospital Accreditation Board had granted Level 1 accreditation (3 years residency training program) to us. I sat down in the clinic and was teary-eyed looking at my cellphone in awe. My secretary came in and asked why I was crying. I told her the good news. Wiped my tears dry. And it was business as usual. Next patient please.

When I got home, I giddily announced to all the good news, my mom included. I took pride in my pediatric staff that we were able to show to all the other clinical departments that we would make the grade for residency program and that Pediatrics would be the first clinical department at Asian Hospital that would do this!

That night, I stayed up in my room making this post. It took awhile to compose it because I didn't really know what to write. But I knew that it was time.

To say goodbye.

But I'm finishing it today.

By saying thank you so much to all of you who have made my three years as chairman of the department a truly memorable one. Three years of getting to know more good people and making friends. Three years of making you part of my daily life. Three years of serving some of the very best pediatricians in the country. And yes, three years of believing in me and in our dreams and making these dreams a reality. I couldn't have been more blessed and thankful with a great, rowdy, crazy, happy bunch of doctors who made each day crazier and yet a blessing for me.

During the first exit interview with the PPS HAB, Gener told me that in all his years as part of the HAB, he has not seen so much love and support from a pediatric staff like the one at Asian Hospital. He told me that if he were to base accreditation for residency programs based on morale of the staff, we would be number 1.

And he's right. It takes people to make dreams come true.

Someone once said that a true leader is not someone who tells his people what to do and when to do it. A leader is a person who points in the direction for his people.

Thank you for giving me the opportunity to lead you.

See you around my friends...