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.

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