Pinoy Kasi : Guilt and guile
Michael Tan opinion@inquirer.com.ph
Inquirer News Service
I COULD tell where the lecture was when I got to the University of the Philippines' College of Medicine last Friday by the way laughter thundered through the building. Which is unusual for the college. Most of the time the classrooms are noisy, but it's because students are discussing, often with long solemn faces, their textbooks and lecture notes.
To celebrate the college's centennial, a series of lectures had been organized, and last Friday, the guest speaker was Dr. Juan Flavier, one of their most famous (or notorious, depending on your point of view) alumni. Speak he did, regaling his audiences with one joke after another, recounting his student days and terror teachers ("We had a test where we were asked to name all the amino acids ... in the order of their discovery."), his short (pun intended) but very fruitful stint as health secretary ("When asked how many people work at the department, I answer, 'Half of them.'") and, for the last few years, serving as senator.
'SSS'
I had first been approached a month or so ago to be one of the reactors at the talk, and I had asked myself, "How do you react to a talk by Dr. Flavier?"
How indeed. The jokes were non-stop, with no sacred cows. There were, to be sure, the usual crop of condom jokes, of vulcanizable condoms for Ilocanos and luminous ones for aging clergy. But that has always been his point: People can't relate to doctors and to the Department of Health (DOH) because health matters are made too serious. Well, they should be, but if you want people to be healthy, you have to make health fun.
I'm going to apologize here as I drop the "Doctor" and "Senator" references (the Inquirer's style is not to attach titles to surnames except with the first citation). So, here goes:
Flavier admits that as health secretary he was merely continuing programs set up by his predecessors but he did add spice to the programs, captured by a catchy "Let's DOH it!" package of slogans and acronyms.
It was during Flavier's term that we were introduced to Yosi Kadiri, a cartoon character epitomizing the repugnance of smoking. We heard, too, the calls to women to conduct "SSS," the Tagalog acronym for breast self-examination.
Language of health
Flavier talked about how we need to tap popular culture, including our love of rhyming words and phrases. I couldn't agree more, and in my reaction, I noted how health educators needed to look at languages other than Tagalog for innovative ideas. Then, too, there's the wealth of folklore, of folk tales and proverbs and riddles. A sample I shared, referring to a very common public health problem: "Paa niya nasa ulo [On the head are its feet]." The audience was perplexed but I finally heard someone give the right answer: "kuto" [lice].
Imagine the difference starting a community lecture by going, "Today we are going to discuss lice," compared with a, "Let's play a game... Guess what..." And for a prize, you would give out one of those special fine-toothed combs.
Words are powerful, which means we have to be careful as well in our choices. I've written about the disaster that came with "Ligtas Buntis," the health department's campaign for safe pregnancy. But in Flavier's time, there had been a "Ligtas Tigdas" program, calling on parents to get their children vaccinated against measles. Ligtas Buntis was interpreted by conservative Catholics as an attempt to pathologize pregnancy, to make it sound like measles and other diseases.
Community health
Jokes and slogans have their place, certainly, in public health, but I do worry at times about the message being overwhelmed by the medium. In some way, Flavier may be a victim of his own success: whenever he lectures, we end up being so entertained that we forget that his main achievement was promoting community health.
Flavier's very ability to make health understandable to the public comes out of his own experience as a rural doctor. In international public health circles, he is remembered for one of his early books where he used agricultural metaphors to explain family planning.
Fortunately, during the talk at the University of the Philippines, the other two discussants were doctors who came out of community practice: Penny Damogo, who was for many years the municipal health officer of Bontoc town and is now one of the provincial health officers for Mountain Province; and Florence Tienzo, who worked for many years with community-based health programs. Both talked about how Flavier had influenced them. Florence, in fact, had a running battle with her parents about her wanting to go to community medicine. Fortunately, Flavier was their commencement speaker and his speech convinced Florence's parents that community medicine wasn't such a crazy option after all.
Guiltless resignation
After Flavier's talk, I told the organizers we need more of these events, not just to "entertain" students and faculty but also to remind them that medical practice includes many options.
Just the day before Flavier's talk, Dr. Olive Caoili of the Department of Political Science at the University of the Philippines in Diliman, Quezon City, asked me if I'd read an article in the British journal, The Lancet, about brain drain among Filipino doctors.
I looked up the essay, written by Victor Alvarez of the Makati Medical Center and published in the June 21 to July 1, 2005 issue of the journal. It's interesting how the article is making its rounds now through e-mail, reaching non-physicians and provoking discussions, including "What else do doctors at the Makati Medical Center need to keep them from leaving?"
Alvarez's essay clearly shows it isn't just economics that drives away our doctors. The article starts by describing how one of Alvarez's friends, a surgeon, went into nursing school with the hope of eventually leaving the country. The article is scathing as it runs through the problems of health care in the Philippines, a long list of frustrations about everything-from the maddening traffic to poverty and government neglect.
Alvarez's essay is entitled "Guiltless resignation." We joke all the time about how Catholics are so saddled by guilt, so the title says a lot about where our doctors are these days. But I can understand how guilt and remorse are bound to disappear when we face so much guile, so much deception on the part of our leaders.
Which takes me back to Flavier. We need to hear him more often talking about what it means to be a doctor, especially in these trying times. He did talk about brain drain during the open forum, the only time that morning where his voice was tinged with sadness. Who would have thought indeed that the profession would need so much soul-searching, grappling both with guile and guilt?
