Monday, February 23, 2015

Manny Pacquiao and the Filipino fear of blood extraction

by Gideon Lasco, MD

In 2009, the much-anticipated “Fight of the Century” between Manny Pacquiao and Floyd Mayweather, Jr., did not materialize, and one of the reasons cited was Pacquiao’s refusal to undergo blood testing before the fight – one of the conditions demanded by his would-be opponent. “I cannot understand his decision,” one sports commentator from The Guardian said, reflecting the general reaction of pundits from the West at the time.

Filipinos, however, were more understanding of Pacquiao’s refusal. "As long as they're not getting a large amount of blood, I am willing to give out blood as close to two weeks before the fight,” he had told a local newspaper. His own explanation – that such a procedure would make him feel weak – was entirely consistent with a belief held by many other Filipinos about blood and blood extraction, and did not diminish the ‘macho’ image and high regard that the Pambansang Kamao continues to enjoy in his country.

More disconcerting than a boxer’s refusal to undergo blood testing, however, is the refusal - or at least the reluctance - of many Filipinos, especially males, to undergo blood tests. A policeman perhaps expressed this apprehension best when he told me: “Tamaan na ako ng bala, wag lang karayom!” (I’d rather get hit by a bullet than get punctured by a needle!). A showbiz headline once read, referring to a famous actor: “Sa kabila ng ka-machohan, Derek takot sa karayom” (In spite of being ‘macho’, Derek afraid of needles). In the Philippine General Hospital, some of our patients would complain: “How I can recover if you’re getting too much blood from me?” Many doctors would be dismissive of these concerns because the usual amount of blood drawn - 5 cc - is medically insignificant, even on a daily basis.

But what is it in blood extraction that causes fear and apprehension among some Filipinos, especially among males?

First, we have to look at folk physiology, or people’s beliefs on how the body works. Many Filipinos think of blood in terms of being “malapot” (viscuous) or “malabnaw” (watery). Normal blood is seen as being in between these two opposing concepts, which are also used by people to make sense of a number of illnesses. High blood pressure is associated with malapot, while anemia and “low blood” are associated with malabnaw. Blood extraction, too, is believed to cause blood to be more malabnaw, hence the weakness.

Consequently, foods that recommended after blood extraction (or blood donation) are consistent with foods that are pampalapot or those that cause the blood to be more viscous. These include balut (duck eggs) and beer. Because blood is seen as at risk for evaporation because of the afternoon heat, those who had recent blood loss including blood extraction are advised to take a bath in the morning.

Many of our patients also think that the blood we have in our bodies is much less than the 5 litres a normal adult male has. This underestimate makes it more understandable for people to be concerned about losing a syringe-ful of blood, let alone the 500 cc in blood donation.

Why is this fear more common in males? Perhaps this is because females, owing to their monthly menstrual period, are more used to blood loss. Also, the being ‘malabnaw’ of blood may be seen as influencing the quality of semen. Some of my patients mentioned the belief that the ‘second round’ of sexual intercourse cannot lead to a pregnancy because the semen is malabnaw. Finally, there might be a fear not just about the blood loss itself, but what the laboratory tests that come after can reveal. We do see patients who do not want to find out about possible diseases in their bodies, thinking that the knowledge of the diagnosis, more than the diseases themselves, can do them harm.

Blood figures in our culture as a symbol of emotion, vitality and kinship. We speak of family as “kadugo”, of heritable traits as “nasa dugo”, and of anger as “kumukulo ang dugo”. But beyond these symbolisms of blood, we need to further examine what is possibly a significant determinant in people’s health-seeking behaviors. Many diseases can be detected through blood tests, and early detection can mean a greater chance of successful treatment or cure. Unfortunately,  many Filipinos delay consult until a disease is severe, and though lack of funds is generally blamed for this reluctance to seek medical attention, surely there are cultural factors we need to consider.

The Philippines has one of the lowest blood donation rates in the world, with 40 per 10,000 in 2010 compared to 73 in Indonesia and 187 in Malaysia. We feel this dearth acutely in hospitals, where blood is always running out, especially during times of dengue outbreaks. Can this low figure be associated with perceptions of blood extraction? The same may be asked of HIV testing, which also suffer from a low rate in a country where HIV cases are on the rise.


The Pacquiao-Mayweather fight is finally pushing through in May 2, and based on news reports, Pacquiao seems to have acquiesced to the drug testing measures. Surely, his reservations about blood tests are still there, but he has let go of them for the sake of “Fight of the Century”.

This should serve as a positive example for many Filipinos who are reluctant to undergo blood tests, or donate blood. Just as Pacquiao might have realised, there are more fearful things than loss of blood. Not getting a chance to fight - be it a boxing nemesis or an otherwise-treatable disease - is one of them.

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