Tuesday, December 30, 2014

A tall tale: Jumping at the stroke of midnight on New Year's Eve to make you grow taller

A girl jumps on New Year's Eve 2015 in Puerto Princesa, Philippines
(Gideon Lasco, 2015)
by Gideon Lasco, MD

One of the New Year traditions that are unique to the Philippines is children being made to jump up and down at the stroke of midnight on New Year's Eve - as high as they can - in the belief that doing so would make the kids become taller. Romulo (2013) adds: "The higher you jump, the taller you'll grow. Even the smallest children are pulled out of their bed so that they, too, can jump and grow taller."

Rod Nepumoceno, a Philippine Star columnist, writes in a January 2014 piece:

I also remember my uncles and aunties telling us gullible kids, "Hey, don't forget, at the stroke of midnight, jump as high as you can repeatedly so you'll be taller" And like a bunch of idiots, we'd jump up and down at the stroke of midnight. I didn't grow up to be as tall as Yao Ming, as I had hoped (that guy probably jumped a whole lot during Chinese New Year). But luckily, I did grow up to be reasonably tall. Well, at least tall enough to have the confidence to go out on dates without feeling too insecure about my height. My brothers and sisters were fortunate, too. But oddly, I have some cousins I jumped with who are still, er, "vertically challenged." Some of them are in their 40s now  and they're still jumping every New Year. I don't know. I'm beginning to think that this whole "jump as high as you can at midnight on New Year's Eve" routine has nothing to do with how tall you eventually become. Could it be possible that maybe, just maybe, genetics has something to do with it? Hmm…

Obviously, the idea that children can grow tall(er) just by jumping up and down on New Year's Eve is a 'tall tale'. But where did that tradition come fom? When and how did it begin? Unfortunately, this is a question that would require archival research, looking at chronicles of New Year celebrations in the past. The most that I was able to ascertain was its existence in the 1940s, as my own grandmother recounted her doing it with her brother. She recalls that "we would be asked to jump up and down by the grownups, telling us that we should do it so we would grow and become taller." My other grandmother said she has no recollection of such a practice, but my uncles and aunts do.

Regardless of the origins and history of this practice, we can learn a lot from its very existence. For instance, implicit in this tradition is the desire to grow tall, which in turn is premised on the premium that our society places on height, or tall stature. This premium is evidenced by many other things we can observe in everyday life, such as height requirements for various jobs, and the proliferation of growth supplements that glorify height (i.e. "Height is Might") and reify the importance of height in society through imagery that invokes basketball, the "tall man's game" that also happens to be the Philippines' national sport (Antolihao, 2010).

Genetics, nutrition, quality of life, and the presence/absence of childhood diseases: these are the factors that have been shown to affect final, adult height. But just like health itself, these things have social determinants, making height itself a function of economics, both on the macro-scale and the micro-scale - though of course there are exceptions: not all rich people are tall, and not all poor people are short. Still, height, by representing these things, acquires a symbolic value that makes tall people "may dating" (with impact) - furthering the social value of both height and its bearer. This is a theme that I am pursuing in my research and I will have more to say about this in the coming months and years.

Going back to the children jumping during the New Year, I wonder if it is height itself that grows taller in the tradition; that is, it the notion of height as an important attribute of the body that gets highlighted, reinforced, and reified by the process of its pursuit. On the other hand, the young people themselves, when I talk to them, do not seem convinced that the jumping will make themselves grow tall. Perhaps they do it because "wala namang mawawala" (there is nothing to lose). Indeed, for children whose heights and fortunes are not yet final, there is nothing to lose and much -- a few more inches -- to gain.

REFERENCES

Antolihao, L. (2010). Rooting for the Underdog Spectatorship and Subalternity in Philippine Basketball. Philippine Studies, 449-480.

Romulo, L. (2013). Filipino Celebrations: A Treasury of Feasts and Festivals. 

Friday, December 26, 2014

New Year and the marginalisation of native fruits in the Philippines

Three kinds of native fruits in Palawan: Even if they are rounded fruits, it is very
unlikely that Filipinos will have these in their New Year's Eve table
by Gideon Lasco, MD

Fruits come to mind as New Year's Eve celebrations loom, because they been part of the tradition of media noche or the New Year's Eve celebrations. Serving 12 rounded fruits, it is said, would bring prosperity for the 12 months of the coming year. In a Xinhua article, Malinao (2013) explains: 

This is a Chinese tradition in welcoming the New Year which the Filipinos have adopted. The Chinese, however, need to have only eight round fruits on the table because the number 8 signifies good luck. For Filipinos the belief is that the 12 round fruits represent 12 months of the year and assure good fortune to the family members all year round.

He adds that assembling this ensemble of fruits isn't difficult: "As a tropical country, it is not difficult in the Philippines to find round-shaped fruits such as oranges, watermelons, mangoes, pineapples, guavas, rhambutans (sic), jackfruits, pomelos and peaches."

Anthropologists have seen fruits as an important part of food culture.  In the Philippines, as in other parts of the world (cf. Manderson, 1987), fruits belonged to the 'cold' classification under a hot/cold categorisation, which implicates foods in illness causation and treatment. Tan (2008:85) writes: "Fruits are considered "cold" and therefore avoided in the morning, the coldest part of the day, with the belief this intensification of the cold condition could result in ailments like diarrhoea and an aggravation of respiratory problems such as pneumonia. Doubtless, this belief contributes to the making of the typical Filipino breakfast, which characteristically does not include fruits, but as looks very much like the rice-based lunch and dinner (Fernandez, 1994). 

There are also certain fruits that have particular beliefs. Eating guavas, for instance, was believed to cause appendicitis - a belief that has parallels in many countries, including the United States where tomato seeds and grape seeds are implicated instead of guavas. Likely impelled by this popular belief, a study by Engin and others (2011) concluded that "most of the people eat fruit seeds and plant residuals do not develop appendicitis generally", but this belief continues to be widely held by the popular sector. Of another fruit, santol, Alano (2008) writes in her column in Philippine Star: "We were mortally afraid of swallowing santol seeds because we were told that if we did, a santol tree would grow inside our stomach. With all the seeds we had swallowed, we would have grown an orchard!" 

There is much more about fruits to discuss in terms of various beliefs ascribed to particular ones, but I would like to dwell on what I consider as a more pressing concern: that of the marginalization of native fruits in the Philippines.

What are these native fruits?  First let me disclaim that the word "native" is not a botanical claim of endemicity, as surely, many of these fruits have actually come from elsewhere, given the Philippines' long history. Rather, I use the term 'native' to mean fruits that can actually grow in the country, and does not have to be imported from elsewhere. These fruits are too many to mention: the atis (sugar-apple; Annona squamosa), guyabano (soursop), langka (jackfruit), chico (sapodilla; Manilkara zapota), macula (Syzygium samarangense), duhat (Syzygium cumini), siniguelas (Spanish plum), and many more. The abundance of these fruits owes to the wealth of biodiversity in the country but also the heritage of international exchange, with some of these fruits coming from the Americas, as introduced by the Spanish colonial settlers.

When I was a schoolchild, I would see mangoes and santol sold as snacks in front of the school, accompanied by rock salt or bagoong (fish paste) as condiments. Bananas and jackfruits figure in snacks like turon, which were sold in the school canteen. Just a block away from our school, there were trees that had wild berries. We didn't have any name for them so we called them 'raspberries' because that was the closest thing we can identify them with. 

Fruits, by themselves and as ingredients, had many roles.

Today, however, these fruits have dwindled in importance. Though the fruity snacks can still be found, especially in rural areas, in many places, they have given way to junk foods, candies, among others. Moreover, it has become increasingly more difficult to find native fruits. Temperate fruits such as apples, oranges, grapes, are most prominent in supermarkets nowadays. Statements like "An apple a day keeps the doctor away" came with the Americanization of education, arguably further strengthening the place of these fruits in our imagination. At a time when apples and oranges were hard to get, they likewise functioned as "prestige foods" (Tan, 2008) - a perception that has persisted today even as their global scale of production and the instruments of globalisation have allowed these fruits to be distributed and sold in the Philippines at very affordable prices.

On the other hand, native fruits have been marginalized. With little demand for them, there was little impetus to conduct research on the fruits, and turn them into commercial varieties. Mangoes, perhaps owing to their sheer deliciousness, have not suffered this fate. However, ironically it is more expensive to buy local mangoes than imported apples or pears. On the other hand,  the dalanghita or dalandan, a citrus fruit which probably has virtually the same nutritional content as the orange, can be had for 20-30 pesos ($0.45-$0.70) per kilo even in Metro Manila - the same price as a single piece of orange. Yet, it is under-utilised, perhaps seen as a "poor man's orange". Whenever I could, I would drink a whole glass of pure, freshly-squeezed dalandan juice in the morning for a half the price of a bottled, artificially-sweetened juice drink!

From both a nutritional and an economic perspective, this disparity is unfortunate. For example, in Palawan, I discovered three kinds of fruits that I never even knew existed: the tabo, the aritum, and another fruit whose name escapes me at the moment (see the cover photo for this article). Harvested from the forests and with flavours rivalling that of the mangosteen, these fruits deserve a wider audience, not least of which because of their nutritional potential. Farmers would have an additional source of income if the fruits that just grow in land would grow in economic significance. 

Much has been said about our agricultural industry languishing, but there is little hope indeed if even the consumers would rather patronize the produce of other countries. We have to celebrate our fruits, not just seeing these fruits as part of New Year's Eve, but as a healthy part of our everyday diet. Scientific studies by our local scholars can advance this cause by demonstrating that the nutritional value of these fruits, not just an apple, can keep the doctor away. Perhaps it is not just the injunction against "cold" fruits in the morning that have discouraged people from buying fruits as part of their everyday diet, but the cost of it. But if only native fruits were to be made more available and affordable, then the population will given a health boost.

This is not entirely a lost cause. Spurred by a growing health consciousness or healthism (Crawford, 1980), the middle and upper classes are buying more varieties of native fruits, and this is evidenced by their proliferation in high-end supermarkets in Metro Manila. Coconut juice has entered the mainstream market as an everyday beverage, certainly a much better choice over those artificial "fruit juice drinks" - and a very sensible drink in a country that has a lot of coconuts. In Indonesia and Malaysia, however, I see jus jambu (guava juice), jus belimbing (starfruit juice), among others, in mall stores - a sign that these fruits are not quite as marginalised as they are in the Philippines. 

We have to take pride in our native fruits if we are to benefit from the nutritional and economic benefits they can give us. This involves, among others, the government prioritising research on these fruits, and looking at ways on how the educational system might have innocuously promoted foreign fruits as 'prestige foods', using them as examples in illustrations and drawings while failing to highlight our own botanical heritage. 

With these thoughts, I wish you a fruitful new year! 

REFERENCES

Crawford, R. (1980). Healthism and the medicalization of everyday life. International journal of health services, 10(3), 365-388.

Engin, O., Yildirim, M., Yakan, S., & Coskun, G. A. (2011). Can fruit seeds and undigested plant residuals cause acute appendicitis. Asian Pacific journal of tropical biomedicine, 1(2), 99-101.

Fernandez, D. (1994). Tikim: essays on Philippine food and culture. Manila: Anvil Publications.

Manderson, L. (1987). Hot-cold food and medical theories: overview and introduction. Social Science & Medicine, 25(4), 329-330.

Tan, M. L. (2008). Revisiting usog, pasma, kulam. Quezon City: UP Press.

Thursday, December 25, 2014

Noni juice and the vulnerability of the Filipino to anything 'herbal'

by Gideon Lasco, MD

In the 1990s, juice from the noni fruit (Morinda citrifolia), popularly known as "Noni juice" became a very popular product with its promise as a panacea or 'cure-all', with purported benefits ranging from cancer cure to increased vitality. Until now, this product lingers in some drugstores and is still being marketed in the Internet as a wonder supplement. However, this fad has been replaced by subsequent others - such as mangosteen and mahogany seeds.

The trend we observe is that first, a product emerges in public consciousness by word-of-mouth and heavy marketing. When this word-of-mouth streams to the level of households, a lot of people, particularly women and those in the older age groups would patronize it. Only after several months or years in which the promised claims have not materialized will people discontinue buying these products. By then, the unwitting family would have lost thousands which could have been used for proven "wellness" therapies such as vaccines. By then, the company that sold the product would have made enough profit to move on to promote the next herbal superstar.

In the case of noni juice, a close examination of its nutritional content reveals that the micronutrient (i.e. vitamin and mineral) content of a noni fruit is just similar to that of a raw orange. All its claims were not substantiated by numerous experiments and trials.

Here an interesting observation is seen: while scientific inquiry puts more emphasis on evidence derived from experimentation and tends to ignore anecdotal evidence, the public is actually more likely to listen to anecdotes of healing. For them it is more tangible and more believable that Neighbor Juan dela Cruz had a tumor that disappeared after he drank noni juice compared to a randomized-control trial of several hundred participants drinking noni juice that found no evidence of its efficacy against cancer. Only "personal experience" is weighed heavier than "anecdotal evidence" by the people, hence, only after months of experience of benefit (or lack) will they decide to continue or discontinue a product. This hierarchy of evidence means that Western medicine still has a lot of steps to take in winning the trust of the public. 

Paradoxically, any highfalutin or scientific-sounding name such as "L-Carnitine" also gets high marks from the public. But this is the topic of another essay.

The vulnerability of Filipinos to anything 'herbal' may be traced to our folk medicine heritage. Long before Western medicine arrived in our shores by way of Spain and America, our ancestors sought ways to cure our illnesses and ailments. As in many other cultures, they looked to the plants and trees in our forests. Some proved to be effective and have since been validated by scientific experiments. Regardless of scientific evidence, however, we value these homegrown efforts to cure our ailments. We have a deep cultural, emotional attachment to these therapies, perhaps reminding us of lola brewing oregano or lagundi leaves as treatment for cough.

It is not just our cultural heritage that makes us sympathetic to herbal products. The modernist ideal of going back to nature, which has its roots in New Age philosophy and a heightened attention to health and the body, has also lent its support to herbal products, vis-a-vis the 'artificial' pharmaceuticals. 

Businesses, particularly ' nutriceutical' companies, can abuse this emotional attachment to herbals by invoking them heavily in their marketing campaigns and sensationalizing the range and potency of their therapeutic effects. The disclaimer "No approved therapeutic claims" cannot compete against images of healing that advertisements portray. This is what we see now. There is need for legislation to curb this, as well as public information campaigns to counteract the unopposed one-sided information in favor of these herbal products. 

The rationale for legislation, as well as public information campaigns, is this: there potential harm in using in 'herbal medicines'. Being pharmacologically active substances, just like any other drug they can lead to overdose, toxicity and poisoning, as well as allergic reactions. Since a doctor usually asks a victim of overdose if he or she has ingested any drug and people don't classify these herbals as such, these cases usually go undocumented or undiagnosed. It must be conceded however that these are rare cases and most herbal medicines do not cause substantial harm to the one taking them.

A bigger danger, however, is if herbal medicines take away the opportunity for a patient to avail of medical treatment and the money to finance therapy that is warranted. For example, doctors see many cases of people consulting for cancer that has already reached Stage IV (the cancer has spread to other parts of the body). When asked why it took a long time for them to seek consult, it is not unusual for patients to say that they decided to first try out a particular herbal supplement. But when the tumor continued to grow, that was the time when they decided to finally consult. Here's the rub: Stage I or II cancer if detected and treated early usually has good prognosis, with a growing number of cancer survivors even living healthy lives and normal lifespans. Stage IV cancer usually kills within several months or few years.

On the positive other hand, emotional attachment to herbals can be used in a healthy way. It could win public sympathy for the research and development (R&D) efforts to identify, develop, and market herbal medicines and that work. This thrust has the potential to reduce our dependence on the mainstream pharmaceutical industry. Cough syrups, many of which are themselves not backed by scientific evidence, are better replaced with a nice brew of lagundi leaves. The Department of Health in 2003 and 2007 launched campaigns for the "Sampung Halamang Gamot" but this is largely under-utilized. 

That we have a wealth of ethnopharmacology is clear. In 1949, soil from Iloilo was isolated to have metabolic products that served as the precursor of Erythromycin, a very important antibiotic and Filipino scientists continue to research on the potential benefits of various plants. The late National Scientist Dr. Conrado Dayrit pioneered research on Virgin Coconut Oil and studies are beginning to show its benefits in various ways. It is already routine practice in the Philippine General Hospital to include VCO in the nutritional upbuilding of admitted children in the Pediatrics wards.

The legacy of our herbal healers has definitely persisted to the present time. It remains to be seen if it will ultimately be for the profit of some, or for the benefit of all.

Thoughts on Filipino words: Lakad (to walk)

Students walk outside  university campus in Palawan, Philippines (Gideon Lasco, 2014)
by Gideon Lasco, MD

Lakad, to walk, does not, in its common usage, evoke images of speed, yet in a nation where things are slow moving - or not moving at all - it has become a euphemism for getting into motion a number of things, from romantic relationships to bureaucratic procedures.

Among teenagers, 'ilakad' means to be a go-between between a boy and a girl. Usually, it is a person of influence who performs this act, by saying nice things about the boy, or creating opportunities for 'boy meets girl'. The performance of 'Lakad' is the antidote to one of the traits ascribed to Filipino males - torpe, which came from the term 'torpid': shy, slow, bashful. Of course, it does not always end up as intended: the boy may end up falling in love with the girl who performs the 'lakad', and that may have been her intent in the first place.

Then, there is another usage of 'Lakad', one that adults encounter more than teens: the facilitation of procedures in the face of a sluggish bureaucracy. There was a time when an application for a driver's license took a month; is it not possible for the application to walk instead of crawl? Same goes with petitions, lawsuits, job applications, and so forth. A way was found to circumvent this pace: ipalakad, to have someone 'walk through' the task at hand, that is, "to make things happen".

The term 'lakad' does not only imply speed, it is also implies access. The performer of the 'lakad' or the 'taga-lakad' can literally walk through the doors not accessible to the general public, and in so doing, facilitate things. He or she is, oftentimes, an insider, a creature who can not only walk (lakad) but also has many hands, a term which translates more vividly as 'maraming galamay', a metaphor for well-connected individuals.

On the other hand, he may just happen to be at the right place at the right time. When I used to work in a government hospital as a medical intern, it was very common for friends, family, family's friends and friends' family, to ask me if I can facilitate the admission of their sick. Amazingly enough, this facilitation - this special access - is sanctioned informally by the institutions themselves; in our case, the relatives of doctors, nurses, hospital staff are euphemistically termed 'extensions'.

What the performers of lakad have in common - among teenage social circles and institutions alike - is that it is people with influence who perform this act.

Possessive of speed and access, amid the backdrop of lethargic, opaque institutions, lakad is an all too convenient term that glosses over whatever illegalities or unethical practices that come with it. It offers not speed in the sense of a race car or a runner, but of speed only in relation to the norm. A government employee who sees himself as upright but has not been promoted for a decade, should he not act? Or in the case of benefits of a retired public school teacher who just died: Doesn't his widow have the right to speed things up if she can, in the name of her children and their future?

There is a whole moral economy in which the performance of 'lakad' is embedded. The beneficiary becomes indebted to the performer of the act and his debt is called utang na loob, a term pregnant with meaning. It will not be surprising if a doctor would return the favor to a lawyer who saved him from a lawsuit by waiving his professional fees in the future. My American brother-in-law wryly commented that Filipinos give each other too much gifts but in a nation where people rely on others to 'set things into motion', it is not too surprising.

We Filipinos have adapted to the bureaucracies and exigencies of life, and have become - wittingly or unwittingly - participants, or experts ourselves. If you get old enough, you'll have an entire ensemble of people to call on to for all sorts of things, from filing your taxes to registering your car. It becomes a way of life, as indispensable in being Filipino as Meralco bills and occasional typhoons.

It is not entirely a sorry state of affairs.

I know of one who needs 'lakad', and that is our nation. Diplomats, politicians, businessmen, people with influence, can advance our cause, and promote our nation's interest. The problem with lakad is that for every person who goes ahead, someone is left behind. But this is not true for larger schemes, such as national endeavors, where everybody benefits. Indeed, if all of us help to 'make lakad' our nation, then it is no longer a walk among shadows. It becomes a march to progress.