Friday, October 8, 2021

[Speech] Message to the students of UP College of Public Health

Speech delivered virtually on October 6, 2021 on the occasion of the 2021 Welcome Ceremony and New Students' Orientation of UP College of Public Health 

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First of all, I would like to express gratitude to the College of Public Health not just for this invitation but the support I have received, moral and otherwise, from people like your Dean, Dr. Jun Belizario, my Universal Health Care Study Group colleague Dr. Emer Faraon, and my contemporaries in the UP College of Medicine, like PM Hernandez and Jimjim Lopez - who I have known since our Intarmed days. I do not say this just to mention people in your college; I say this because I really feel so much at home in UP Manila because of the support I have received in my various activities. Someday, I look forward to collaborating with your college and I hope I get to meet you. 

But of course, I also feel at home in UP Manila because it was literally my home for several years, from the time I was an Intarmed student to the time that I finished medical school. I lived across Taft for three years, and in a dormitory in Orosa Street for another four years, I have seen shops and restaurants come and go - Sala Thai near PUP, Iseya in Padre Faura, Cyma our long-time favorite in Rob Manila. Gone is the computer shop where we used to play DOTA; gone even are the buildings where we used to have our lectures. But of course Robinsons in still there, and I’m sure you’ll get familiar with its every detail - including the escalators and restrooms that are out of service.

Today, with a pandemic upon us, my student days seem to belong to the remote past. But just because things have changed doesn't mean that we have to let ourselves bogged down by the thought of that change. Leadership involves rising to the occasion, and while I do not underestimate the personal challenges we all face today, I believe that by being here, and by choosing public health, you have what it takes to be leaders, whether in scholarship, community-building, teaching, or public service. Once, when I was hiking in Japan’s Mt. Hiei - the site of Ruruoni Kenshin’s epic battle with Shishio, it was foggy I couldn’t see anything, then suddenly a monk appeared, and asked me: “Why are you here?” And I said, “I want to climb Mt. Hiei”, but he repeated: “Why are you here?” And I realized that what he really asking is “Why are you here in this world at this moment?” 

I still think about that question from time and time, but today I am convinced that the reason why we’re here is because we refuse to accept that the pandemic has defeated us. We refuse to accept a future where public heath is a privilege, not a right. We refuse to accept that we have stopped growing as individuals. We are here, whether as teachers or students, because we believe that we can make the future better than the present. 

 But we cannot be future-looking all the time. Being in college, or taking that master’s degree, is not just a step in a ladder, it is a chapter in your life that is as important as the previous and the next. I think that I speak for the faculty in saying that your happiness, your sense of fulfillment and meaning with your life today matters to me much just as much as your service to the country, even as I also know that the happier you are, the better you will be able to serve. Aside from wishing you success in your future career, my hope is that you will be able to make the most of your student experience, in academics and beyond. And so, in 10 minutes or so, let me share some advice as you embark on your college journey on this time of great uncertainty. 

First, never allow yourself to get envious of the past, never think of your student experience as inferior or incomplete because of this pandemic. I know that it is disappointing, and even depressing, to start college or grad school this way. I know that it’s almost two years, and the lockdowns upon lockdowns are increasingly unbearable. But don’t think that this virtual platform will make you any less of a student. Focus instead on what you can do, from learning from the pandemic itself. Like a volcanologist who does not welcome a volcanic eruption but will nonetheless use it as an opportunity to apply and grow their field, we can learn from this pandemic, and we can evolve our way through it by developing our skills in independent learning, in online teaching, in virtual fieldwork, and so much more. 

Second, use your privilege wisely. Not everyone will have this opportunity to learn. Not everyone will have fast enough Internet; some are struggling to have Internet access at all. Even before the pandemic, studying has been a privilege. This is no need to feel guilty about this, but aside from acknowledging it, one way we can respond is by maximizing our opportunities and using it to improve ourselves so we can better help other people. 

Now one of the nice things about being a UP student is that you get to meet people from all over the country. My love for traveling was developed with my visits to my classmates during sem breaks and summer vacations - including my first trips to Mindanao. I’ve learned so much from my travels since, andI would advice you to travel whenever there’s an opportunity, with the caveat that, in this age of Instagram, I hope you will travel but not for the world to see you, but for you to see the world. But of course today we cannot even go out of our homes, we cannot even go to campus, which brings me to my third advice: Read. Read. Read, because books can also take you places. Books allow your imagination to travel, and it can be as rewarding as traveling itself. When I was in med school I used to go to the Booksale in Robinsons Manila and I made it a point to read one a book every week. I think it helped me a lot, and I think it will help you too: To the graduate students in particular, I must say that you that if you want to write your thesis of dissertation easily, you must learn not just to read but to enjoy reading. 

Fourth, I hope you realize that “ambitious” is is not a bad word. In the Philippines, “ambisyoso” has a negative connotation, and even “trying hard”, but If public health is grow, then you must be confident in your ability to expand the field. I think we have to celebrate a certain degree of bibo-ness in all of us. A few years ago, I told myself that in terms of productivity, my goal will be to publish one tweet a day, one column a week, one journal article a month, and one book a year. At that time, it seemed unreachable, especially the one journal article a month and one book a year. But this year, I’m happy to say that I’m on track to meeting this goal - I will be launching a book on “Drugs and Philippine Society” later this month. With practice and perseverance, I realized that one’s goals, no matter how ambitious, can be realized. I think we in the Philippines have much to share to the world in terms of public health knowledge and experience, and we must be ambitious in taking leadership in global health. 

Fifth, do not be afraid to question experts, including your professors, but do s with humility, with the acknowledgment that you could be wrong. During the pandemic, I have found myself at odds with some of my own professors. For example, I was one of the first to question the value of face shields especially outdoors. But I have continued to engage with them privately and I have refrained from personal attacks. Public health can be divisive because it is not an exact science. But there is far more that unites us than divides us - from the importance of vaccination to our demand that health care workers and researchers get due benefits. I hope that you will join us in trying to make public health a true community: one united by shared goals, shared experiences, and shared values. 

Sixth, never let go of who you are. Sometimes, especially in the health sciences, we think of our careers as a series of steps towards increasing specialization. From health you become a doctor, then you become an internist, then a cardiologist then an interventional cardiologist. But while we cannot be a jack of all trades, we don’t have to let go of our backgrounds, the things that make us unique. You can be plural in your career, in your professional identity. This applies to non-academic stuff too. In college, you will meet people from all walks of life, and sometimes you cannot help but wish you had some of their abilities, talents, looks, and lifestyle. Some will be effortlessly good in public speaking. Others will be physically fit and toned no matter how much they eat. Some will have so many Instagram followers, others will have the best condo. Never let go of who you are, because without realizing it, you also have something unique that can enrich you even further if you pursue it. I really loved mountain climbing, but when I was in college I had hardly anyone to climb with. I didn’t realize that mountain climbing was also a key to making so many friends, and I’ve climbed with so many people from all walks of life because of the mountains. I’ve also learned so much about our country and our world - having climbed in all kinds of places. The mountains have been a source of strength which is why I have been a steadfast environment advocate, it’s the least I can do for the mountains that are dear to me. 

Seventh, be generous with your time and your emotions - but reserve them for people that matter. I remember recently this celebrity saying that she could get by with 100 pesos a week as a student in La Salle, we were all students before and most of us will feel at some point that we never have enough. But while allowance is limited, your emotions are boundless. Do we look at our emotions as something can be generous about? It is frustrating to see all the problems of our nation and the world, but there is already so much good you can do at an individual level, from explaining vaccines to engaging relatives and friends, on matters of politics. However, I’ve also learned to reserve my emotions for people who matter. Because of my column and my tweets I get trolled a lot, I’ve even faced legal harassment, and it can hurt. But I don’t hate these people. They don’t deserve my love, but they also don’t deserve my hate. I don’t have time or space for hatred. There’s so much to do, there’s so much good we can do. Expand your concept of generosity to include time and emotions, and you will enrich the people around you. 

Finally, this is a moment of overlapping crises in our country and I’m sure you’re thinking about where you want to be in the future. I for one don’t believe that you necessarily have to be in the country to be of service, but do not lose hope, because there’s so much we can do in our lifetimes, and of course there’s no place like home. Remember - we are not a small country and there’s so much diversity and beauty within us. We are not a poor country and with better leadership, we can do so much with our wealth of knowledge, creativity and solidarity. A poet once said: “Don't stay where you are needed. Go where you are loved.” In the Philippines, you are both loved and needed. And so always reserve a space in your heart for our beloved country. With those thoughts, I conclude this message and I wish all of you the best in your public health journeys, with the hope that we will see each other along the way.

Mexico City, October 6, 2021

Thursday, September 23, 2021

[Panel Discussion] #PHCON2021 - Indigenization of Public Health

On September 23, 2021, I participated in a virtual panel discussion on the "Indigenization of Public Health" as part of the #PHCON2021 organized by the Philippine Society of Public Health Physicians. Joining me in the panel were Dr. Renzo Guinto, Dr. Meredith Labarda, and Dr. Ryan Guinaran. 

I highlighted the importance of looking at structural barriers to participation as well as the value of long-term engagement with indigenous peoples as a way to facilitate inclusivity in times of crises. I also underscored the importance of the social sciences in helping bridge medical and local knowledge. 

Friday, August 20, 2021

[Speech] Message to the students of UP Manila College of Arts and Sciences

Speech delivered on the occasion of UP Manila College of Arts and Sciences' Araw ng Pagkilala 2021 on August 20, 2021

My esteemed colleagues; my friends in the UP Manila community; and our dear students: 

I was a young and naive 17-year old from UP Rural High School in Los Baños when I went to UP Manila. I was an Eagle Scout who of course knew how to use the compass and even at some point how to build a fire, but the first time I used the LRT in Pedro Gil I got lost and ended up in the opposite direction. On our first week, two of our blockmates had their cellphones stolen in Padre Faura, and learned early on that the thieves can smell who the newbies were from a mile away. Back in those pre-iPhone, pre-Netflix days, Pedro Gil was filled with vendors selling VCDs, and the most introvert-friendly way to make friends is to add them on Friendster.

Diliman, they said, was much better campus, but we eventually warmed up to UP Manila, including our favorite part of it - Robinsons Mall. I visited the Booksale every week hoping that I would be lucky enough to find good books, encouraged by the Haruki Murakami novel - Norwegian Wood - that I bought for 50 pesos. I usually did, and I made my policy to read one novel every week. 

As an Intarmed student, I actually spent a lot of time in AS, which during our time had the strictest security guards ever. I don’t remember what my grades were, except for 2.5 in Calculus. We had colorful, unforgettable professors, like the legendary Ma’am Gavino, our History instructor Sir Esguerra, our Humanities Ma’am Achanzar, and many more. Now that I’m a UP faculty now myself, I realize that when you’re standing in front of the class you can see everything that students are doing - from watching NBA games to scrolling their Twitter and reading books totally unrelated to the course. And all I could do is to tell myself: Karma is real. 

It would be nice to continue my reminiscence because I want to impart to you a glimpse of how your college memories can be a source of strength, joy, and even laughter, in the future. Maybe today, you know even the student number of your crushes, but someday, it will feel like an achievement to remember your own. 

But at the same time, I know that we are faced with more pressing natters today, amid this pandemic and the seemingly endless cycle of lockdowns. When I graduated in 2010, a new president was about to take office, but we did not have the sense of uncertainty we have today. Certainly, we did not have this pandemic that has changed every aspect of our life, including this ceremony during which I cannot even see you face to face.

And so I cannot be a guide for what’s going on today, the way a mountain guide knows the way and takes hikers up the summit. Some might use the metaphor “we are on the same boat” and that’s quite apt since the word ‘barkada’ literally means the same: people of the same barko. But I also know that the pandemic has divided the privileged and the under-privileged, and has exposed the inequity of the world - including in your personal lives. Many of you have struggled greatly over the past one and a half years, which is why surely, this moment comes with a mix of emotions, and I do not feel adequate to the task to giving justice to all of them.

Even so, along my journey in UP Manila and beyond, I would like to remind you of three things that I learned along the way that might be of help as you continue your journeys through and beyond this pandemic. 

First, always remember that you are plural. Do you remember that UPCAT application form when you had so many choices but in the end you can only take one? Life is not like that. You do not have to choose just one thing. You can choose two. Or three. Or more. Of course you have your chosen career path but don’t let your life be limited to that. Don’t let your career define you. Some of you are singers, dancers, writers, actors, activists, leaders in different fields. Do not let go of your hobbies and passions. Hold on to them like a child misses their blanket. Nothing is too petty or unimportant if it means so much to you. My mountain climbing has sustained me throughout of my life, giving me so much confidence and strength. I refuse to downplay it. It’s an integral part of my life, co-equal with my writing, with my research. They all make me who I am, and none is less important than the other. Because I loved medicine and the social sciences, I tried to find a way of combine them and I’m so happy with my career as a medical anthropologist. There are ways to mix and match your strengths, talents, passions especially with today’s technologies that have enabled you to pursue more. I actually composed songs for the musical we produced as part of Ma’am Achanzar’s Humanities 2 class and maybe someday I would like try that again too. 

Plurality, by the way, can extend to identity - you can be a proud Mindanao, Bicolano, Palaweño, Filipino, Asian, and whatever else you end up, all at the same time. At a time when we are forced to choose between different identities - race, ethnicity, gender, or even professional affiliation - we can be all of the above - or none; we should welcome plurality not as a threat, but as a fulfillment, of our individuality. I. 

Second, always remember that as individuals, you are promising, and you continue to be. No matter how prestigious your university is, no matter how big your achievements are, it is easy nowadays to feel incomplete and inadequate. Maybe today you feel that you’ve underachieved, especially if you compare yourself to others. Maybe you felt that because of the pandemic you didn’t learn enough. 

But let me tell you that the best way to look at achievement, and at ourselves, is not as a product, but a process. The UP education did not take you to the top of the mountain, it did not even take you to a certain trail, but it taught you some skills how to climb, how to find your way, and if needed, how to find your way back. And along the way, learning has to continue, like a Final Fantasy character that keeps leveling up. How can you live up to that promise, in ways that avoid what BTS calls an “imaginary swamp” of worries and expectations? In my experience, aside from the medical training itself which taught me so much about life and death, traveling has given me perspectives that I needed to know myself and to understand the human condition better. Once the pandemic ends, travel as much as you can - but do not travel so the world can see you, but so you can see the world. There are different ways to travel - you can travel to Japan and just eat matcha and sushi all day. I don’t mind that! But you can also go to the country and learn about its history, its society, not just their technological marvels but also their societal challenges. 

Aside from traveling, I would add reading, which is like traveling with your imagination.

And then there’s practice, which is essential for any endeavor in life. When I started writing a column, it took me four days to write one piece. Nowadays, it takes me around four hours. When I started writing academic papers, it took me over a year to write one piece. This year alone, I've published 12. Keep practicing, and you will get there.

Finally, you are not just plural, you are just promising, but you are powerful. I know that this is hard to say in the middle of a pandemic, it might come off as naive.

But only if we define power in narrow terms. There are things we can do, both as individuals, and as communities. I have not solved the vexing problems of vaccine inequity and hesitancy, but I’ve managed to convince at least 13 individuals - family and friends - to get vaccinated, by giving them information and vouching for the safety of vaccines. As UP graduates, you have the power to influence the people around you. On whether or not to take a vaccine. On who to vote. On even what to eat; how to leave healthy, non-toxic, positive days. To those of you who will be pursuing health related careers, you have a special power to help other people. We will not always be able offer cure, but we can always offer care. 

Sometimes, our power lies in the most underrated life skills, like encouraging people, introducing them to new experiences, and mentoring them. Somewhere in your high school, or hometown, there’s a kid looking up to you, and your words can mean so much to them. Somewhere in your community there’s a pantry, a local initiative, and your support can mean so much as well. 

Remember, you are powerful because kindness is powerful. 

And you are powerful because science is powerful and those of you who will pursue the track of research can improve people’s lives. The very fact that it’s possible to protect yourself with vaccines today speaks of the power of research to improve people’s lives and we should never take that for granted. By science, of course I also mean the social sciences, which can diagnose the ills of society, and point out to the structural barriers to our people’s health and happiness. Science can be used in the service of authoritarianism, of corporate greed, of human vanity, but with moral courage, it can also be used to challenge them, by pointing out its weaknesses, contradictions, and harm - and pointing towards sustainability and equity in our ways of life.

Finally, you are powerful because arts are just as powerful and important as the sciences. During the lockdown, when medicine failed, it is the music, film, TV series; the stories and songs that kept us going, offering the beauty and hope that reminded that the world is still worth fighting for. UP Manila is the health sciences university, and AS fits right in the middle because the arts can heal. The arts can heal, and again with courage, they can also heal our nation. 

And so, our dear students, my colleagues and friends, fellow learners, let me end not with a challenge, but with a benediction: 

May your plurality allow you to maximize your life and realize your potential.

May your promise translate to the betterment of your families, communities, and our beloved country. 

And may the power that lies within each of you lead to a better, safer, fairer, and more inclusive world. 

Amherst, Massachusetts - August 4, 2021

Wednesday, August 18, 2021

[Panel Discussion] Asia and the Pacific Youth Symposium - Health & Wellness

On August 18, 2021, I moderated the Knowledge Session on Health and Wellness as part of this year’s Asia Pacific Youth Symposium organized by the Asian Development Bank. Building on the first-ever APYS last year, the session was envisioned as part of an intergenerational dialogue for the exchange of knowledge and experience on pressing matters involving the region, in ways that mobilize young people as partners. 

In the event, Shruti Mehta discussed how can we reduce NCD prevalence through MYE in sports investments, as well as through youth-led behavior change on harmful habits, diet and exercise and Trisha Lamban, a 19-year old mental health advocate from the Philippines, talked about engaging her peers both online and offline. Meanwhile, Rui Liu, a health specialist with ADB’s Health Sector, shared lessons learned about youth health during the pandemic and some insights how we should approach this topic amid a so-called ‘new normal’, and Prof. Susan Sawyer provided an overview of the state of young people today - as well as the current and potential opportunities for meaningful youth engagement. 



Sunday, August 8, 2021

[Speech] Medicine as a Journey: Commencement Address to UP College of Medicine Class of 2021

Speech delivered on the occasion of Salimbay: UPCM Commencement Exercises 2021 on August 8, 2021

Let me begin my saying that I am greatly honored by this privilege of being able to address you, Class 2021, this year’s new batch of doctors, and that my only regret - one that I’m sure you all share - is not being able to do this with all of us gathered together. We have taken it for granted, but now we know that something is lost when we do not see each other face to face. Something is lost in this brave new world of social distance, when we could not even gather together to celebrate this moment; a moment that recognizes all that you and your loved ones have labored to realize.

And yet, at the same time, we lose even more when we refuse to make the most of what is available to us. Whether it’s telemedicine, a Zoom lecture, a virtual gathering like this, learning must go on, healing must go on, and we are here today because we refuse to accept that this pandemic has defeated us. We are here because we believe that there are many forms of togetherness, including that involves not so much being in the same place, but sharing the same principles and values. And we are here because we believe through medicine, a future where humanity can thrive remains possible. And that the dawn for our country remains within reach. 

But what kind of medicine? In addressing you today, I wish that I could afford myself the privilege of reminiscence and reflection; of assembling some anecdotes and words that can hopefully inspire you and make you feel good about yourselves. But I know that doing so will not do justice to a ceremony that is being held amid the most devastating health crisis in our lifetimes. And doing so will not do justice to where your thoughts dwell today. And so, even as I still want this speech to be about you, as new doctors and as more-than-doctors, we must grapple with these questions at the outset: What kind of medicine can allow us to overcome the crises of our time? What kind of medicine can give people the dignity that they deserve, empower them, and actually improve their lives? What kind of medicine can you, Class 2021, offer the people? 

If we are to answer these questions, the first step is a willingness to acknowledge that while our profession has shown remarkable heroism, some of our paradigms have been problematic even before the pandemic. 

Despite paying lip service to the value of preventive medicine and the social determinants of health, the view of health as primarily a matter of individual responsibility has led to a focus on individual, mostly pharmaceutical, interventions. Healthy environments. Protected forests. Good housing. Access to quality public transport. How many times have we prescribed these human needs that are both preventive and therapeutic? Predictably, this is the same paradigm that has been applied in the pandemic, with individuals being told to do all kinds of things, wearing face masks and face shields, getting themselves vaccinated, even as what we also need to prescribe more forcefully is government action on various aspects of the pandemic - testing, supporting communities, reasonable. and as result, the burden of the pandemic has been borne by the Filipino people. 

The view of medicine as top-down, and quite frankly, authoritarian, has led to disempowering discourses, and again, this has been the case even before COVID. Convinced that all the patient has to do is to comply and follow instructions, we have not emphasized communication skills, medical humanities, social sciences, in our curricula; we have not recognized the value of therapeutic alliances with families and communities, and we have neglected empowering and encouraging individuals to take charge of their own health. As a result, we would rather trust a drug to lower people’s cholesterol instead of working with them to change their lifestyles, instead of demanding for environments where such lifestyles are possible. Again, predictably, we see this reflected in the pandemic with people, including doctors, telling the public to just listen to us, just follow us, sumunod na lang kayo.

Finally, our view of medicine as separate from politics has led to abandonment of our role as attorneys of the people, most especially the poor, and we have not heeded Jose Rizal when he told his students in Dapitan that “knowledge without courage is useless”. And so, as institution, as a profession, we have avoided hard questions of people in power; we have been quick to reprimand the powerless, but slow to call out the powerful. Is this because of another pathology in our field, which is that we are too hierarchical? Regardless, and again predictably, we see this during the pandemic, where - despite the good intentions of many of our colleagues - what we see is policies-based evidence instead of evidence-based policies. 

 Thankfully, I think that you can see through these paradigms, in pat because I know you are critical thinkers who can fact check your professors not follow them blindly. And also in part because our alma mater has no shortage of people who have asked the same critical questions; we come from a university that activism as a form of public service; and we come from a country that demands that we ask those questions if we are to survive. 

 But perhaps what you’re wondering is how you can adhere to these principles without being burnt out. And apply them in ways that actually make an impact. And, perhaps most importantly, how you reconcile them in your life, which you also want to be enjoyable as it is meaningful. 

Today, I want to contribute to your thinking by suggesting that to be effective in your medicine, you need to strive not just to be good doctors, but to be more-than-doctors. Even though medicine will be a big part of your identity, I do not think it should necessarily define you. I hope you remember that there are far more letters in your name that than the MD that you can now add to it. 

And so, please allow me to return to one of our TRP songs, for inspiration. Not just because I composed it, but because in this rare honor that you have bestowed upon me, I feel that I speak for my batchmates in Class 2010, and our collective experiences. The song’s name is ‘Paglalakbay’ and today, I would like to speak of medicine as a journey. 

The journey is more important than the destination. 

 Thinking of medicine as a journey reminds us of its uncertainty, of the risks involved, our Austronesian ancestors who sailed across the oceans, like the traditional healers who trekked through mountains in search for medicines; like the doctors of old who braved disease to bring about cure. Of course, there’a also the sense of adventure, the sense of wonder, the curiosity that can lead us to pursue research; the curiosity that can lead us to better. And the excitement that can keep us going.

But one of the things I would like to emphasize is that like all journeys, the journey itself is more important than the destination. In fact, the root of the word journey means “day”, emphasizing our daily activities - not our lifelong goals.

Doubtless, today is an important milestone. But milestones are literally reference points to see how far we are in relation to a certain destination. I love climbing mountains and I must admit that I used to think of hiking the same way, always looking at how far I am from the summit instead of looking around me for the beauty that’s already there. To just give you one example, I missed a once-in-a-lifetime opportunity to see a Philippine eagle in a mountain in Bukidnon because I was such a hurry to reach the peak and I wasn’t paying attention the trail. 

How many more years before you finish medical training? I know you’ve been asked this question many times, and you will be asked it many times more in the future. Many of you will have different answers to that question. Many of you won’t have a definitive one.

Regardless, don’t just count how many years there are before you reach your dream. Count the days and the moments you have with your family, your classmates, your friends. If your grandparents are still alive today, spend time with them. And of course, the same is true with your parents, mentors, loved ones. Life is not a mountain, or a career ladder, that you require to climb. It’s a long distance trail. Can we look at each chapter in our life - college, medical school, residency, fellowship, as equally important independent of where they lead to? 

This insight is applicable to our patients as well. Can we think of our encounters with our patients as curative acts in themselves, regardless of whether they can lead to treatment? Chemotherapy might lead to cure, but a reassuring tone, an empathetic explanation, can ease the anxieties and the pain of the moment. In a profession that’s increasingly based on numbers, we need to remind ourselves that words can heal. Words can heal, and their effects can be both immediate and everlasting. I remember a friend of mine once tell me that the reason he became a doctor is because once when he was in grade school, his teacher told him that “I think you can be a doctor” and that sentence was imprinted on his mind, giving him confidence and faith. Mindful of the value of each moment, do we recognize the value and the power of our words and actions?

This is not an invitation to disregard the future. In fact, living in the moment prepares you for the future too. If you invest in your mental health today, you can be better prepared to deal with the stresses of tomorrow. If you look at yourselves as more-than-MDs today, then you can better doctors in the future. 

And so, do that 5k run! Take that yoga class. Learn that language you’ve always wanted to speak. Climb that mountain. Play that piano piece. Write that poem; write that essay your reflections on the health care system. Pursue that research, that project, that business, that advocacy. Dance. Bike. Live! And be generous with your emotions. Open your heart to the possibilities of each day. If there’s anything that medical school should have taught you, it’s that you can never be too busy for the things and the people you love. 

This includes your own body, too, and you must be a good doctor to your own self. If I can give pragmatic advice in the middle of this address, it’s that you take care of your bodies. This is hard to do because we too are subjected to the same structural challenges that undermine our people’s health. At a personal level, what’s going on in our country can stress us out. And at a personal experience we experience the bad policies, the lack of access to public spaces. All we really had in med school was Rob Manila, which I could navigate with my eyes closed. Because of the stress and the lack of other options we loved to eat a lot and I still remember the post-duty breakfasts when we ate to our heart’s content. But you all know that by now you are reaching the age when metabolism slows down, and you have to start thinking twice before you order extra rice. Looking back, I wish I had run along Roxas Boulevard more, that I had gone to the swimming pool in Vito Cruz more. But it’s never too late to mind your own wellness. Be kind to your bodies, because you need them to be healthy and strong if your journeys are to be long and winding. 

Detours are welcome

So far, I've talked about how journey that’s more important than the destination. The second insight is that we must be open to the possibilities of detours; of itineraries that keep changing; of a journey that may look completely different than the one that you envisioned. In other words, while we have our dreams, we should also open our hearts to the world and to whatever possibilities or opportunities will come. 

When I entered medical school, I never thought that I would be a medical anthropologist. Because of all the science fiction that I read I thought it would also be cool to study neurology and be at the forefront of exploring whether the mind can ever be connected to computers. Later on, because I excelled in doing ABG and inserting IV lines in infants, even neonates, I thought I could do emergency medicine. But I’ve always been curious about cultural practices, and in fact, I think I was the first student to take the Ethnopharmacology elective in LU 5 which involved going to an indigenous community and documenting their herbal medicine. I dragged along our class president, Dr. Beverly Ho, we went to Ifugao, and we really enjoyed the experience. In succeeding years, in LU 6 and 7, I got introduced to the work of Prof. Michael Tan - who became my mentor - and other anthropologists, I realized that I could combine my passion for the social sciences, and my medical training, while being able to pursue a lifestyle in line with my other passions, like climbing mountains and writing essays. 

 Importantly, I was convinced that by articulating the cultural determinants of health; by exposing the political pathologies that hold back our nation and our people, medical anthropology is both diagnostic and therapeutic. It is diagnostic because it unearths the sources of illness, from corporations that profit from selling unhealthy food to politicians that benefit from touting populist responses to the pandemic. And it is therapeutic because it promotes empathy towards our people while demanding accountability from those who exploit people’s health and illness. 

As you can imagine, it must have been disappointing for my parents and grandparents that I would not be the doctor they might have envisioned - wearing white coat in his clinic. But they were supportive of my decision, and I do hope that you will have loved ones who will be equally supportive of you as well. Please never take their support for granted. I have to also say that I’ve experienced incredible moral support from our faculty in UPCM and I am so grateful for that.

Ultimately, though, it is still your decision. Take your time to decide. Do not count a year off as a loss, view it not as delay but as a detour. Whether it’s getting married, having kids, being a consultant, gaining a fellowship, buying a house, or reaching a certain achievement at a certain age, never allow your life’s journey to be defined by milestones set by others. Take your time to achieve your dream specialty. And to those of you who will not pursue a clinical specialty, never ever feel incomplete. Take not that precisely because of the flawed paradigms of our profession, pursuits like activism and community service may be perceived as “prestigious” as other tracks. But we can always resist and reject such ideas. And regardless of what stage of life you’re in, you can always do something else, or something more. Like the board exam that you’re about to take, and for which I wish you all the best, "all of the above” is often the correct answer. Remember, again, that you are plural; you are more-than-MDs. We are encouraged us to be five-star physicians who are decision-makers, managers, communicators, community leaders, health care providers. And I agree that within medicine, you can do so much. But at the same time, the constellation of things you do can go beyond medicine itself; you can be five star persons too.

Part of the problem is a comparative paradigm that we end up applying to ourselves. However, you can also end up setting milestones for others, including your classmates. Class 2021, if there’s anything you can do for your classmates is that you build a supportive, non-judgmental environment that will empower them to pursue their dreams. And of course, please recognize that the people, including your classmates, who have been part of your journey.

Is it worth continuing this journey?

Finally, if medicine is a journey, then like any other journey, there is the possibility not just of detours, not just of side trips, but of stopping, or even turning back. After all, being a doctor is not just an identity; it’s also something that you choose to do every day. Indeed, you may already be doctors, but it’s still a decision whether to answer that call for help, to go beyond your call of duty, to pursue advocacies, to speak out, to be involved in community work, and to do more for your patients, not just treating their illnesses but trying to address the reasons why they get sick in the first place. 

 The pandemic has made it even harder to make these decisions. COVID-19 has arguably increased the stature of heath care workers in society, but at the same time the pandemic has increased the hazards of our profession. Aside from being in the medical frontlines, some doctors are finding themselves in the political frontlines too, and it’s not just the virus that can deal us harm, but our fellow humans - especially those who are addicted to power. 

And so we ask: Is it worth continuing this journey? Is it worth pursuing a medicine that not only looks at individual patients but looks at the environment, at our politics, economy, culture, to uncover the structural determinants of health? And is it worth fighting for a life that is determined to go beyond medicine in order to fulfill your other dreams and passions? 

These are questions that only you can answer. But if we find ourselves willing to continue in this journey, but lacking confidence or hope, then there is no shortage of people whose footsteps we can follow to take it step by step. 

If an ophthalmologist named Jose Rizal can open his people’s eyes to the oppression of colonialism by using his gift of writing, his creativity, his courage, then so can we keep going. 

 If a medical graduate named Bobby Dela Paz can push for a community-based health program even if such a program is deemed an act of subversion, even at the height of Martial Law, then so can we keep going. 

If doctors to the barrios like Dreyfuss Perlas, Sajid Sinolinding, Rose Sancelan, can choose to stay in their communities despite the risks involved, they so can we chose to stay in our places of calling. 

If a pediatrician named Karen Senen can sing songs even amid COVID, determined to live a full life, determined to keep serving others, then so can we carry on, amid the crises of our time. 

If nothing else, then it’s worth taking to heart that our vocation is important because people are important, every life has value and is worth saving. When you chose the word ‘salimbay’ to christen this moment, I felt that it applies not just in illustrating your own promising, exciting careers about to take flight, but the kind of medicine you can offer: With your knowledge and skill, you can actually give people a chance to soar in their lives. Indeed, there are wings in the anatomy of hope, but at its heart is empathy, and the conviction that human life has value. 

This is why we are hurt and rightfully enraged when people, including our own leaders, trample on human rights. This is why we protest when people reject the knowledge, the evidence, the science that could save people’s lives. And this is why we speak out when we realize that we are treating patients only to send them back to conditions that make them sick. If our journeys can somehow advance this mission of saving lives, while giving you the fulfillment of living your own life fully and meaningfully, then I say it’s worth taking. 

And so in the name of all is that good, all that is true, all that is beautiful, and all that is worth fighting for in this world, I exhort to journey on, to keep soaring, to keep dreaming, to keep climbing; and to keep healing, inspiring, and uplifting others along the way. 

Mabuhay ang Class 2021. Mabuhay ang inyong mga paglakakbay. Maraming salamat sa inyong lahat.

Friday, May 14, 2021

[Webinar] On the Frontlines: Filipino/Filipinx Healthcare Workers - New York University

On May 4, 2021, I joined Emerson Ea, Assistant Dean at NYU's Rory Meyers College of Nursing and Clinical Nurse Manager Kym Villamer in discussing the experiences of Filipino healthcare workers in the Philippines, United States, and beyond, in a session moderated by Wagner Professor John Gershman and organized by Sulo: Philippine Studies Initiative at NYU, KJCC, Robert F. Wagner Graduate School Office of International Programs, Rory Meyers College of Nursing, and the New York Southeast Asia Network.

In my presentation, I argued that healthcare workers in the Philippines are not just in the medical frontlines, they are in the political frontlines as well, serving as voices of reason (and resistance) amid the incompetent response of the Duterte administration. 

More information at NYU Wagner.

Friday, April 9, 2021

[Webinar] Insights for public health policy - Philippine Public Policy Network

On April 9, 2021, I presented a talk analyzing the Philippines' pandemic response as part of a webinar organized by the Philippine Public Policy Network, entitled "Moving to the Next Normal: Behavioral Insights for Public Health Policy". Joining me in the session moderated by Dr. Jalton Taguibao were Prof. Marie Fe Mendoza who gave opening remarks, Joanne Yoong who offered behavioral insights, as well as Senator Risa Hontiveros who related the pandemic with universal health care. 

My presentation focused on the following 'pathologies' of the country's COVID response, namely (1) the 'responsibilization of the individual'; (2) "covidization” of health care; (3) “one size fits all” solutions; and (4) (mis)use of science and expertise. Taken together, these elements characterize what I call 'medical authoritarianism' in the country. 

Sunday, January 24, 2021

[Webinar] Preparing the Frontline for the COVID-19 Vaccine Rollout: Learning from the Past

On January 22, 2021, I joined a panel of experts in sharing regional experiences about vaccination as part of the webinar series organized by the BMJ, Asian Development Bank and UNICEF to "explore key challenges from past vaccine campaigns and facilitate a discussion to support countries with their Covid-19 vaccine rollout.

I shared a presentation entitled "Vaccine risk communication: Lessons from the Philippines" which center on insights from the dengue vaccine controversy, drawing on WHO guidelines for vaccine safety communication as framework.  

Joining me in the panel were Dr Patrick L. Osewe: Chief of Health Sector Group, Asian Development Bank; Ms Lulu Ariyantheny Dewi, Epidemiologist, Immunization Sub‐Directorate, Ministry of Health Indonesia; and Ms Wendy Erasmus, Chief Health, UNICEF Pacific Islands. The webinar was moderated by Dr. Ashley McKimm, Director of Partnership Development, BMJ.

For more information and for a future upload of the recording, please visit the BMJ website.