Withstanding the tempests

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During the wedding anniversary of one of my aunts, Divine Mercy Parish, Sikatuna, Quezon City. Feast of the Divine Mercy, 2015.

Recently, my Lolo Max comes to mind quite frequently. Interestingly, it’s not through specific memories of being with him, but through recalling his life advice. Most useful for me now is how he taught us to weather the figurative tempests in our lives: difficult memories and their accompanying emotions.

Once in a while, in between projects and busy schedules, memories come to mind which evoke a variety of emotions. Some give solace in times of stress, others stress in times of relative ease. Inevitably, there will be people, places, things, and other sensory perceptions that would produce emotions that are just too difficult to ignore.

I guess that this is the innate difficulty of someone having a keen sense of memory, something that was definitely useful back in college. But just as how this facilitates unwieldy emotions as much as pleasant ones, I have come to realize that managing memories and the emotions that accompany them require the ability to step back and look at the greater picture.

Perception of the greater picture, for me, is just like looking at the satellite picture of the Earth, with all kinds of clouds forming seemingly out of nowhere. Some clouds turn into storms, others into thinner clouds that bode well for outdoor activity. This perspective teaches me that emotions are just like these storms, they come out of nowhere, but also pass away.

Further supporting this realization is a personal experience of our family more than two decades ago, back when my parents were adjusting with the new life we had to adjust to in the province, after living the first eight years of my life in the city. My mother was having difficulty managing all of the adjustments–new language, new way of life, new office–and she sought the advice of my grandfather. My grandfather Lolo Max, the wordsmith that he was, wrote her about the “need to withstand the tempests,” and “being well-assured that everything shall be well after the storm.”

I quote him now with bare assurance of accuracy, as I was only able to read that letter when I was in third grade; it had been lost. But with how things went for the better and how negative events and emotions have come and gone, I now realize the wisdom to withstand the tempests, and being well-assured that all shall be well indeed.

The last instance I was able to share with him was the pain of rejection after not getting accepted for further training. I remembered him giving simple yet practical advice, effectively cutting through his senile-looking self. He first asked me what I was planning to do next. When I replied that I was going back to the academe, he simply told me, “galingan mo na lang sa ginagawa mo (do well in what you are doing),” and continued to challenge me to excel and reach the pinnacle of the career I have chosen.

This, from a man who despite his advanced age, endeavored to learn and show his innate strength, who even toyed with the idea to attend law school, and who in his youth took on a variety of jobs that showed his multi-disciplinary prowess. A native of Southern Leyte in the Visayas, he was a photographer, a painter, a writer, a poet, and a traditional healer. In his sunset years, to pass idle time, he would read from law books he had borrowed from my parents, and made effort to ask about current events. On the day of his death, I even felt a strong force pulling my legs out of bed, which happened at about the same time he had lost consciousness. I now choose to believe that that was his way of telling me that he would always be with me, and that I should always stay strong.

To stay strong and keep trying, knowing that difficulties come and go, memories and emotions are transient, and everything shall be well: that was his advice. I have since chosen new paths to follow and places to leave behind, some amicably and unfortunately some not, while nevertheless knowing that all shall be well.

It’s been almost a year since Lolo Max died, and as I navigate the world with all its drudgery, tears and joys, his advice continues to inspire.

Thank you Lolo. I miss you.

 

Breaking the hiatus

It’s been a while since I was able to write anything on my blog. But for the past weeks, I’ve been very happy balancing my teaching with real world experience, both in the field and in engaging with health policy researchers and decision makers.

For instance, thanks to my friends in a health policy consulting firm, we are helping public health program managers develop integrative policies. In another project I’m doing, I am mentoring colleagues who are developing their skill in health policy and systems research in government health agencies. In yet another project with foreign colleagues, we are aiming to identify points for improvement in health financing in Asean. On top of these is my work with #HealthXPh and mentoring our community medicine rotators in an urban poor community in the south of Manila.

There has been so much to learn from my interactions from various collaborators, both within the country and internationally, that I have been very enthusiastic to bring the learnings back to home turf, in the college where I work. Melding these lessons with my own experiences in public health strengthens my drive even more. I feel a certain sense of responsibility to share these things to my students. I have to show that in aiming to serve the poor and marginalized, the way to go is to be ready to accept different views, insights and changes.

But, expectedly, change will be unacceptable at the start, just like the evoked feeling of unusual pasalubong that relatives bring home from a foreign country. Sometimes, the seeming initial rejection is enough to frustrate, even leading one to move on and look for more appreciative venues.

Nonetheless, this isn’t enough reason to give up.

Though I will agree that it takes skill and practice to pitch one’s ideas, change and progress have to be embraced. Change is never easy. Like how stressed aquarium fishes tend to get after the water gets changed, it’s understandable if one’s efforts towards increasing awareness and building self-reliance seem to backfire at the start.

This brings me to why I try to adjust the way I teach: the world isn’t getting kinder.

Five Filipino doctors, three in public health and two in clinical specialty fields, were killed within the past six months. These deaths may be due to a variety of reasons, but as someone who shared in their career paths at one point of my life, I feel that these deaths are a manifestation of how our health system is enmeshed with politics, governance, business and other seemingly unrelated pursuits, and how future doctors have to be well-equipped. Meanwhile, an increasing number of colleagues have been victims of doctor shaming, where doctors exercising their ordinary care and diligence are being berated on social media for various reasons.

We need doctors who will not rest on their laurels.

I believe that getting ready to practice in a world afflicted with these things requires a balance of versatility, proactivity and discipline. Those traits may well be cultivated in good class attendance, in diligently solving a biostatistics problem, or recognizing the merits of producing a creative work. Meanwhile, the lack thereof may well be demonstrated in cases in which health professionals would fail to provide the prescribed intervention to destitute patients, by not making do with limited resources, or doing something to address the lack. This is the kind of situation I would like to prevent, since lives hang in the balance.

Despite the odds, I am optimistic. I know it may be difficult for my students, but I hope this gets to them: we are in this together. I share in the difficulty, since learning how to be an effective mentor is difficult as well. Nevertheless, for the sake of our changing world and the patients we serve, the journey has to be trod. The good news though is we can moderate the pace of the journey.

But not too slow. The world and our patients anxiously await.

Academe and public health

Life in the academe at first glance can be just like any other job; like in all other careers, one gets involved in a rat race with the aim to climb up the career ladder, to gain both reputation and higher remuneration. Not to mention the privilege to brandish one’s fancy academic attire year after year during commencement.

This was my first impression of the academe, when I chose it as an alternative career track after finishing a stint in government. I intended to do research to supply evidence that will support health policy in my country. Also part of this motivation was to share my experiences to students and fellow faculty.

I soon realized that this was not just what the academe is all about. Now, almost four years since I chose this career track, I now fathom the immense importance of the academe in pushing further the boundaries of knowledge, and defining what it means to be in public health. Cliche as this may sound, accomplishing such a duty entails finding new approaches and concepts to teach to my students, making sense of current and emerging trends in my field of endeavor, and catalyzing discussion on how to solve the problems of the world today. 

All these sound like mammoth tasks to achieve, but what I find deeply consoling in the academe is that all these starts with the stroke of pen and ink. In an attempt to respond to real world needs, we academics write the ideas brought forth by deep introspection and analysis of the problems set before us. 

Pragmatic thinking may dismiss academic publishing as non-productive; indeed, matters discussed for the sake of discussion with action as mere afterthought are often deridingly deemed moot and “academic.” But my experiences in the field taught me that academic writing serves a uniquely important purpose: it serves to challenge norms and paradigms, allowing us to zoom out of conventional ways of solving problems, and propose suitable solutions. 

In my past work in public service, I aimed to solve public health problems while looking at the context of my clientele: their culture, their socio-economic concerns, and their collective aspirations. I believed that using this approach would result in interventions that are acceptable, affordable and appropriate. 

However, many public health programs were implemented by following checklists and monitoring success indicators that were determined by program managers and policy implementors who were marginally aware of the context of the target population. I couldn’t blame them, as this was the only way to ensure well-monitored progress of health improvement for a budding health system such as ours. 

In this system, these interventions started with a written plan, which usually followed a certain template set by legal and bureaucratic protocols. Though there was room to propose adjustments applicable to the local setting, due to the sheer volume of work, health officers would just stick to accomplishing bare minimums. 

In this system, many an implementor would be wont to say: As long as our scorecard wasn’t red in this indicator, I’m OK. As long as I’m not rock bottom in my province, I’m OK. As long as I don’t have any maternal or neonatal death in my jurisdiction, I’m OK.

Indeed, it’s OK. But does this lead to achieving the “best possible state of health?”

Back in medical school, I was introduced to the concept of working towards the “best possible state of health for all,” a principle upheld by the WHO Alma-Ata Declaration on Primary Health Care in 1978. Despite its battlecry for community-managed health care and “health in the hands of the people,” due to various practical reasons, health care became fragmented, compartmentalized, and indicator-driven, both in government and private sector health management; what, with the emphasis on financial accountability and the need to prioritize interventions that generate the greatest apparent return of investment.

Clinging to my belief in providing the best possible health care for all while being aware of the current practical difficulties in implementing the Alma-Ata Declaration, I felt that approaching health problems from an academic standpoint would enable me to zoom out from this state of affairs, and investigate approaches that would truly produce the best possible health. 

This is why I chose to be in the academe. I still believe in health for all, and I want to be at the forefront of how it is to truly achieve it.

Why I travel

Since childhood, I’ve always dreamt to travel the world.

Now that my career objectives are becoming clearer, I now choose to believe that this passion for travel serves a purpose: it reminds me of how I should be open to new perspectives and experiences. Very useful, especially for someone carving a career in the academe.

In the middle of my mid-year vacation in Taiwan, I met up with a public health researcher from another Southeast Asian country, four years my senior and already a post-doctoral research fellow at Taipei Medical University (TMU). In between more light-hearted topics, I was asked by my new friend about the research I was doing. With cordial but hard-hitting frankness, he told me that my subject matter is already obsolete, and I need to look at new angles to solving public health problems.

I was stunned.

Thankfully, he invited me on short notice to attend an international public health summit, a collaboration between TMU and the schools of public health of the University of Tokyo and the National University of Singapore. I expected that it would be a chance to be updated. I was looking for a new conceptual framework on which I could help improve my thinking patterns as a budding researcher in my field.

Gladly, I wasn’t disappointed. There were three key messages that I picked up from the summit:

  • More than just focusing on the science, public health needs to develop its own art. It should provide solutions that not only address superficial needs but also, “hidden commitments” and cultural norms, which require a more creative approach.
  • Public health should shake itself off from a fragmented, health service-oriented conceptual framework imposed on it by biomedical science. As it is a public discipline, it needs to integrate points of view from implementors, academics and frontline health workers. It needs to be led by people who know how to carry out interventions, promote them and assess them.
  • Finally, public health should provide its practitioners with the skill to zoom out of the picture and recognize one’s role in maintaining health security. This should go beyond political boundaries. As a partially recognized political entity without benefit of full membership in various international organizations, Taiwan is quite experienced with this. In pushing for a greater role in maintaining health security, it used one of its most powerful forces: its academe.

Somehow my experiences have taught me these things, but it is gratifying to hear these lessons straight from the experts.

This gathering reminded me to regularly zoom out and connect with like-minded researchers who have amassed experiences and have become prolific authors. When asked about his secret, my new friend told me that it’s all about being passionate for one’s chosen field of research. If one is indeed passionate, he would be willing to sacrifice time and resources to achieve one’s goal.

I am happy that these realizations became part of an already existing passion for travel. But I’m more happy now I now have a better reason.

It will challenge me to be more productive, as I continue my goal to bring the barrio doctor voice to the academe. It will allow me to become a better public health researcher.

Finally, it will allow me to work better towards the goal of promoting “health for all.”

***

Thanks to Dr. Tuyen Van Duong for inviting me to this event (and for taking the picture above), and for Dr. Don Prisno for linking me up with colleagues at Taipei Medical University.

The speakers at the International Public Health Summit at TMU were Dr. Masamine Jimba, professor of community and global health at the University of Tokyo, Dr. Chia Kee Seng, dean of the Saw See Hock School of Public Health at the National University of Singapore, and Dr. Kuo Nai-wen, dean of the school of public health at TMU.

A prayer of thanksgiving

Today is my birthday. As a Christian I would like to thank God for the past thirty years with this prayerful song.

Blessing and glory, 

wisdom and thanksgiving, 

honor and power 

and might be to our God, 

forever and ever, 

Amen, Amen, Amen.

Wonderfully unusual

NOTE: This post is my participation in The Blog Rounds 3.0, where doctor-bloggers write about a certain topic of shared interest. This week, a moderator suggested we write about this: what would have been my career if I didn’t choose to be a doctor? 

***

College yearbooks here in the Philippines have this special quirk: not only does one have a picture dressed in academic attire, but also a creative shot, in which one could choose to wear anything, portray anything and be anything. Usually, it’s something else aside from the career one has chosen to study.

Being in a pre-medical program, it was almost certain that all of us would end up in medical school. So almost all of my classmates chose not to include anything “medical” in their creative shots. They imagined themselves as fairies, anime characters, or movie stars.

Always the class rebel, I chose one of the pictures taken of me while working in the hospital. It manifested how I really wanted to live my life as a medical graduate: that I’d rather live my life pursuing my passions than living life confined within the hospital. 

This is of course, not to denigrate those who have chosen to serve as hospital clinicians. I know what it takes to do so, and I have great respect for them. But as for me, I never liked life in the hospital. Because of this, in the course of my professional life I explored non-clinical and even non-medical career options. 

In short, I loved being a doctor, but I wanted to know how else could I become a doctor aside from being a clinician. Honestly, I initially didn’t have any concrete idea of what I wanted, and as a result I allowed myself to go with the flow of things. To my relief, these experiences led me to a greater idea of what I want in life.

So to answer the question: I think I would still be who I am now. 

How did it turn out?

Allow me to walk you through various stages of my life that allowed me to get to where I am now. It is actually a very opportune time for me to do this. In a week’s time I turn thirty. The added decade seems to tell everyone that this person has experienced a lot. For the past few years, I sure did.

After going through various difficulties and diversions along the way (which even included multi-level marketing at one point), I graduated from medical school at the age of twenty-four. I subsequently worked for the government health service in the rural areas of northern Luzon, and ended my stint as a rural physician at twenty-six, having done a lot of stuff in between: a member and eventual officer of a Toastmasters club, and a member of a charismatic prayer group. 

After my stint in government service, I was still not convinced that the hospital life for me. I then took on a personal journey that took me to a lot of places and situations, and allowed me to adopt various roles. 

Choosing not to pursue specialty training, I instead chose to become a researcher and educator, first in the state university, and later, in the college where I now work. Eventually, I tried out a live-in vocation discernment program, while trying out things like teaching morality and ethics to high school students, learning philosophy and theology, and writing assignments for literature class.

Perhaps by now this account has become a dizzying list of things that I’ve chosen to do instead of settling with a clinical specialty. Perhaps you’re wondering how I’ve been able to put up with all this; especially since every change of career represented the start of another journey. It’s always tiring to start something new. Why did I not choose something stable right away? I don’t know either. Maybe I’m free-spirited, a rebel without a cause. Or am I?

Notwithstanding, I’d say that I was able to go through all this as a way of learning how to live independently, to live alone and purposefully while not feeling lonely. It was more of force of circumstance than anything else. My family emigrated when I was twenty-five, four years too late for me to be included in the immigrant visa petition that allowed them to leave. It started quite painfully, having been raised in a deeply religious and tightly knit environment. 

But I felt that destiny had something in store for me with that event in our family. The nights I’d have to spend far away from family would have to be nights where I can dream and imagine how I can make a mark in the world. And thus, allowing me to try a lot of things.

In the mountainous region where I served, I was a manager by day, and visionary at night. I spent my nights dreaming for the best to happen to my area of assignment, looking at successful case studies, and thinking of how to make things better for the community I serve.

Back in Manila after that stint, I was a researcher and educator by day, and still a visionary at night. I wanted my research to impact on the lives of people I encountered as a rural physician. I wanted to speak on behalf of rural physicians and represent their interests in academia and policy. I wanted to soar and take the barrios with me. It was a tall order, and for me it was a sweet burden to bear. But destiny had another surprise. It led me to consider the possibility of living the religious life.

Under the tutelage of a prominent religious order, I joined a ten-month vocation discernment program, a sort of religious ‘aspirancy’, where I realized how important it is to get in touch with oneself, with all its quirks, emotions, desires, feelings and aspirations, which often come up recurringly in the frequent solitary prayer periods and the schedule I shared with my co-formands each day. It felt like heaven on earth, but it had difficulties too, which I felt were far outweighed by the spiritual advantages. At one point, I concluded that maybe this was the stable life I’ve always wanted. But at the back of my mind, I wondered what had become of my vision to soar and take the barrios with me. 

That question got answered after the ten-month program. I was notified that I was not to continue religious formation. Letting the dust settle after such a disturbing outcome, I knew they had good reasons for doing so. Perhaps they saw that I was better pursuing my rural-oriented academic goals. 

Nonetheless, I was devastated. Sometimes the pain can still be felt at times; it has only been only a little over the year since it happened. Frantically I prayed for answers, looked around and tried to zoom out of the situation. 

Thankfully, after getting back on my feet, going back to my halted academic career and reconnecting with friends and colleagues, I then realized that maybe, I’m better off in continuing my attempt to soar and lovingly take the barrios with me. And do so much more.

I rediscovered my passion for health care social media, and reconnected with dear friends at #HealthXPh. I learned how to write again, do public speaking, do research and teach again. But, armed with experiences of rejection and disappointment, as well as an enduring vision to do great things, I knew I wasn’t “crossing the same river” anymore, as Heraclitus wrote in a famous philosophical fragment.

Still, everything feels surreal.

“Surreal” would describe a particular experience that seems extraneous from mundane reality; in other words, something unusual. Something extraordinary. Modestly, I wouldn’t want to describe my life journey as extraordinary, but I do agree that it had been quite unusual. 

Wonderfully unusual.

And I can only be grateful and happy, for being the kind of doctor I’ve always wanted to be.

My journey with #HealthXPh

I would like to thank people who attended the recently concluded Philippine Healthcare and Social Media Summit 2017 (#HCMSPh2017) held in Cebu last 25 April.
The summit, now on in its third year, is organized by #HealthXPh, a community of Filipino doctors with a common passion to promote social media as a means for health awareness and patient empowerment. 

But aside from the summits, actually, the main activity of this community is the weekly tweetchat held every Saturday night, where we discuss various issues and their impact on health and clinical practice. Unique with this chat is a refreshing friendly environment, a respite from the hierarchy characteristic of the medical profession. After all, more ideas spring out when people are open to express themselves freely.

Starting as an endeavor shared by a group of friends, #HealthXPh was started by endocrinologist Dr. Iris Isip-Tan, orthopedic surgeon Dr. Remo Aguilar, medical educator Dr. Buboy Tapia, and occupational physician and patient advocate Dr. Gia Sison. Eventually, obstetrician-gynecologist and community maternal health advocate Dr. Helen Madamba joined the fold. At every step of the way, #HealthXPh was supported with fatherly care and support by trauma surgeon and former undersecretary of health Dr. Ted Herbosa. 

Then late last year, through my inclusion in its regular rotation of tweetchat moderators, I became part of the group, and became its bunso, its youngest member.

Until now I’m awed at how I managed to be part of such a formidable cast of clinicians and advocates. How did it happen? I don’t know precisely. What I do know is that I have been participating in the tweetchats since the group’s infancy, and I just found myself gravitating towards their mission and the fun-loving personality that they share as a group. 

For me, participating in the tweetchat populated by global and national movers and influencers required a lot of chutzpah. But after receiving news about the first tweetchat in late 2013, I felt I just had to join the conversation. Having just ended my stint in the Doctors to the Barrios program, I developed a desire to share my experiences and learn from others as well. #HealthXPh was the venue I was looking for.

In the interim, I have been on and off with my participation in the group, having been busy with other matters. But I knew that the tweetchat habit was more than anything else as I eventually realized that my Saturday night was incomplete without it. It complemented the health policy research I do for a living, and more importantly, taught how to communicate my ideas effectively through social media. Most of all, it has become like family.

Thankfully, about late last year I had the opportunity to adjust my schedule and make time for the regular tweetchat, and develop a great friendship with its regular participants. Before I knew it, we were planning together for a national summit, that to my pleasant surprise they have been organizing annually.

It gives me a warm and fuzzy feeling inside that a national healthcare social media initiative began as a tweetchat organized a passionate group of friends, and that they have given me an opportunity to be part of it.

I share this story as an invitation to people who would like to contribute to the success of health care social media in the Philippines. Attending the HCSMPH is just the beginning. Join us in the #HealthXPh tweetchat every 9PM Saturdays, and let’s exchange ideas. Who knows, your idea might just be what our country needs to achieve better health!