Withstanding the tempests


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.


Decisions, decisions

In my tenure as a municipal health officer, there were two things that demanded much patience and diligent preparation.

One was whenever I would propose a project to the municipal council, in which case I had to write project proposals, talk to stakeholders and check with the budget officer, accountant and treasurer if my office still had enough remaining funds.

But for me, a more important and challenging task is this: deciding how to apportion the allotted budget for the coming year. It should be a well-informed and well-decided process, since a well-planned budget stands to benefit a lot of people.

The task of proposing a budget is one important application of decision science: what would influence an important decision, especially if people rely on it?

Another is deciding how much medicines to request from the health department. To give a backgrounder to this arrangement, in the Philippines, the funding and staffing of health offices at the municipal level have been devolved to individual local  governments. The national department of health (DOH) only provides technical assistance and augments resources by providing medicines and facilitating upgrade of health facilities.

One program the DOH implemented during my tenure was the Complete Treatment Pack program, in which medicines are packaged not by bulk nor individually; they are packaged with the goal of providing the complete course of treatment for patients, especially important for antibiotics.

For instance, a patient requiring amoxicillin, a medicine for bacterial infections, will receive enough medicine to complete the recommended treatment: three capsules every eight hours for seven days.

But this program has a list of drugs to request. For me, the difficulty of relying on previous health statistics to decide on this is the possibility of running out medicines if in case an outbreak occurs. This is why making decisions like this should also consider the context of the target communities: what are their potential exposures? What are their lifestyles? Would I have a good reason to get ready to treat many patients with non-communicable diseases?

Decision making is an essential skill in public health, and it should not just be made out of the desire to exert power: it should be based on what the community really needs.

Who is a barrio doctor

A few days ago, while mentoring junior medical interns doing their community medicine rotation, I received a text message from a fellow doctor-blogger. It wasn’t good news.

Jim pls check out FB and twitter another DTTB killed

Still reeling from the impact of the yet-unresolved killing of Dr. Dreyfuss Perlas, who graduated from the Doctors to the Barrios program one year after I did, I barely managed to keep my composure as I excused myself and caught up with the news. It turned out that the victim was Dr. Jaja Sinolinding, brother of DOH-ARMM secretary Dr. Kadil Sinolinding Jr. Dr. Jaja and his security escort were shot Tuesday morning, 18 April, by a gunman who had pretended to be a patient in his Cotabato clinic.

Notably, as news about the tragedy spread through news and social media, Dr. Jaja was tagged by DOH Secretary Dr. Paulyn Ubial as a “barrio doctor.”

Strictly speaking, at the time of his murder, he wasn’t part of the DOH Doctors to the Barrios program. He was an ophthalmologist who chose to establish his practice in Cotabato instead of putting up shop in more affluent areas in the country. His death has shown that the risks of serving the underserved do not only affect physicians who have chosen to join the Doctors to the Barrios program, nor those who became municipal health officers or rural doctors. It affects all health professionals, regardless of one’s specialty, as long as one has chosen to unflinchingly stand up for what is right.

Notwithstanding, in my opinion, amid the horrific circumstances of his supreme sacrifice and despite his specialist affiliation, Dr. Jaja has affirmed what it really takes to be a “barrio doctor.”

By choosing to put up practice in the provinces, he shared in the commitment to provide care to the underserved, despite the risk. Dr. Jaja provided free consultation services, and, as affirmed by people who worked with him in Cotabato, was a well-loved doctor.

By choosing to consider medicine as service and not a means for personal profit, he shared in the commitment to ensure that health is accessible to all.

Finally, by choosing to serve despite existing threats, he exhibited unparalleled courage.

Definitely, he was a barrio doctor.

A barrio doctor who, along with Dr. Perlas, deserves swift justice.