[Speech] Commencement Speech - UP Baguio 2025 Commencement Exercises

This speech was delivered at the Baguio Convention Center on the occasion of the 2025 Commencement Exercises of University of the Philippines Baguio, on July 22, 2025.

Distinguished university officials, chancellors, deans, representatives of our different campuses, esteemed professors, dear guests, colleagues, family, friends, and of course, the 526 graduates that we celebrate today, a very pleasant afternoon to all of you.

On this momentous occasion, I also want to honor our ancestors and pay respect to the Indigenous heritage both across our archipelago and here in Baguio, to the Ibaloi and Kankanaey, to all the peoples of the Cordilleras, to the generosity of their land, and amid histories of injustice, their enduring legacies of agency and resistance.

Finally, I also want to acknowledge that we live in a more-than-human world and recognize the
plants, the animals, all the species with whom we share the space around us, as well as the
bodies of nature, which our ancestors rightfully saw as living beings. And of course, the Creator, the author of life. Being closer to the heavens, surrounded by the Cordilleras, the mountains of my youth gives me strength; may they remain forever green, and may our rivers, our lakes, our seas, and our oceans remain forever blue.

In my life’s journey, I have seen many rainbows, many wonderful things, but perhaps the most
magical thing that I have witnessed is the possibility of change, change for the good and
change for the better. That within each living thing lies the potential for growth.

And that in our broken world, there is the possibility not just of build, build, build, but of repair, of renewal, and of regeneration.
And so the first message I would like to share is this:

Give others a chance.

Who among you has been let down by somebody? Maybe in a group report—someone didn’t make the slides, didn’t make it on time, didn’t make it at all.

Or maybe you became disillusioned by someone you looked up to. Hurt by someone you cared
for. Disappointed, even disgusted, by the political posts of someone you know.

Today it is easy to block, unfollow, cancel someone in response to what we think of as their
failings. But human are complex, imperfect beings. Someone you think is lazy in class might
actually be a working student busy at work. Someone who seems unfriendly might just be shy. Once, I had a classmate who never joined us for lunch—only to realize, years later, that he
simply couldn’t afford to.

When we see the life stories behind the IG stories, we might be inclined to understand instead of judge, to support instead of punish. It actually costs less to support someone through
school than to keep them in jail, but our society is good in rewarding success, but not in
supporting people so they can succeed. Can we recognize that maybe our education can allow
us to understand others better, and to support them more?

I know that this is not always easy or advisable, and there are times when you have to stay
away from toxicity or negativity. But in this age of cancel culture, be someone who gives others
a chance.

Secondly, give yourself a chance as well.

How many of you have fallen asleep in a lecture with 30 people people? 10 people? 5 people?
Well, once, I fell asleep in a small group discussion during our pediatrics rotation, and there were only three of us. “Do you feel refreshed?” The professor asked when I finally woke up.

We’ve made many mistakes, and I’m sure if you look back in your years in UP, you wish you
could have done things differently. Perhaps you wish you studied more. Or perhaps you wish
you studied less, and that you tried out new things.

Giving yourself a chance means recognizing your privilege and your potential, your capacity to
learn from your mistakes, improve yourself, and never give up on your dreams despite pressures,
artificial milestones, and the weight of expectations.

Speaking of expectations, there’s the understandable desire to meet our parents' expectations and so to the parents here, I want to ask of you, in behalf of our graduates, please give them the space to follow their path, they’ve made your dreams their own, please make their dreams yours as well.

Since I was a kid my dream was to climb mountains. Memorably, I climbed Mt. Pulag when I was 17, back when it took three days to climb Ambangeg Trail, and I cannot forget that it was
dog named Chica who guided me to the summit.
After Pulag my next big target was Mt. Apo, and I felt that I needed to climb it before I turn 20.
Even when my companions backed out, I decided to go, accompanied only by two Bagobo
brothers who served as my guides.

When I finally started hiking, I was so happy, because I was finally about to realize my dream.
But it started raining, and very soon I was soaking wet. We were taking the Kidapawan trail,
and we had to cross the river many times, by just walking on coconut trunks! It was nerve-wracking and although managed to not to fall, I
was exhausted.

Finally, we arrived at the campsite, and I managed to pitch my tent and fell asleep out of
fatigue.

But when I woke up in the middle of the night, my Boy Scout tent was wet, and I was shivering
in the cold. And to make things worse, I could hear the sound of even-heavier rain, and I could
even see flashes of lightning. I felt angry and miserable. There I was, alone, inside a tent, so far from my dream.

But I needed to pee.

At first, I tried to sleep again, ignoring the call of nature. But I couldn’t do it, and eventually, I
gave up and unzipped the tent, bracing myself for the cold and the rain.

To my surprise, there was no rain. What I thought was the storm was just the sound of the river
that we had crossed. And what I thought was lightning, turned out shooting stars. Above me,
there was the Milky Way, the brightest, most vivid night sky I’ve seen in my life, and the next
day, I reached the summit.

Sometimes, we give up on our dreams too soon—because we misread the signs. We mistake
fear for failure. Discomfort for defeat. Detours for dead ends.

But if we give ourselves a chance, if we step outside of tents, our comfort zones, then perhaps we’ll see the stars and surely we’ll be on our way to reaching our dreams.

Thirdly, give our country a chance.

I know that it is not easy to feel hopeful about the country, especially when you see the corruption, the impunity and the injustice. The roads that take forever to build. The traffic, the lack of green spaces and quality public transport, the slow Internet.

In the name of development, we quarry mountains to build new cities. In the name of progress, we cut pine trees to build more malls.

Alas, we are still far from being a country where Kian de los Santos can freely study, and where
Chad Booc can freely teach.

But the Philippines is not a small country, and our country is larger than all of the above. We are not a poor country, either. Saying that the Philippines is a poor country runs against our
heritage of wealth and richness, which is why we were colonized and exploited in the first
place. Saying that the Philippines is a poor country naturalizes the fact of our people’s poverty, obscuring the violence of its provenance. It is like saying that someone “is dead” when the more accurate way to put it is that “he was murdered.” Saying that the Philippines is a poor country sets low expectations for our government, serving as an excuse for incompetence, negligence, and corruption.

Actually, other countries have the same challenges and frustrations too. When you hear people say “only in the Philippines”,chances are, it’s actually not true, and in fact, I’ve heard the same expression in other countries, like Solo en Colombia and Unik Tiada Tara in Indonesia. Realizing that many of the problems we face are actually shared by others, can pull us from the despair of imagining ourselves as innately flawed and fundamentally hopeless.

What gives me hope is our long and living legacy of resistance. Macli-ing Dulag and Ama
Lumbaya who defended the Chico River. Pascual Pocding, who fought against the construction of a dam in Itogon. The people of Sibuyan Island, who blocked mining trucks with their bodies and successfully blocked a mining project. When I asked the forest guards in Mt. Kitanglad how many trees they’ve planted, one of them said “around five” — and when I incredulously repeated my question, he said, “Yes, five. Hectares.”

What gives me hope is the kindness I’ve encountered across the archipelago, the hospitality, of the people of Babuyan welcoming us with lobster. Hikers in Sulu sharing their best coffee. Friends, classmates in med school, opening their homes, opening my heart to what country is all about. Once, I lost my cellphone in a jeepney in Maguindanao. I had given up on ever seeing it again, until I got a call from a family who found it and wanted to return it. When I offered a reward, they refused. “We’re just being good Muslims,” they told me.

What gives me hope is you and all the talent, all the energy that you can bring to this country.
When I say give the country a chance, I do not mean passively watching it change, but actively
participating in making the change possible.

We need the arts, literature, and the humanities to open our hearts and minds to the beauty,
diversity and richness of our country, and at the same time remind us of our shared humanity.
We need communications to bridge our differences and empower communities.

We need the sciences - biology, ecology, physics - and mathematics to help us understand the
universe more, to take leadership for the challenges we face today. And in this age of AI, we need computer science not just to harness future technologies but to make sure it will not only benefit a select few.

And yes, we need social sciences - history, economics, sociology, anthropology, development studies, Indigenous studies - to help us understand each other, to ground us in a past is deeper than colonialism, and to guide us in a present that is full of challenges are not just
technical but political and social. There’s actually enough food to feed the world, but problem
is distribution.There’s enough information, each of us have more information in our smartphones than Rizal ever dreamed up. But there’s also disinformation, and the challenge is learning and critical thinking, which is why we need to work together, from different fields,
different perspectives. With all our efforts, our country has a fighting chance.

But what you do not know, you cannot appreciate, what you cannot appreciate, you cannot love, and what cannot love, you cannot fight for. Perhaps what gives me the confidence to say these things is that I’ve known this country, I’ve immersed, I’ve put my heart in it, and I encourage you to do the same. For me, it began with traveling - hiking, going places. One of my sidelines, when I was a student, was as a mystery shopper for Cebu Pacific. I had free
flights, but I had to pretend to have a headache each time, to test the flight attendants, so it
also required some work.

But it was a lot of fun, and even today, having been around the world, having lived in different
places, I can say that I love the Philippines, and I am happy to invest my time and my energy in
this land. I do not know how many countries you can visit without a visa, but I know of 82
provinces. And each can inspire you to give this country, our country, a chance.

Fourthly, give the planet a chance.

Today, we face overlapping crisis. Even as we speak, a genocide is being live-streamed from
Gaza, and many look away, as hospitals are bombed and children are gunned down. Before
the pandemic, I had the opportunity to visit the Rohingya camps in Bangladesh and alas, it is
just one of many examples of how much cruelty and suffering humans can inflict on one
another.

And then there is the climate crisis. We face the specter of hotter, more inhospitable world, with
worsening storms, not to mention the ever-present threat of eruptions and earthquakes, like
the one that shook the very place we’re gathered in, twenty five years ago.

Even as we have finally overcome COVID-19, the threat of future pandemics looms, alongside
emergent hazards to our health, from ultra-processed foods to microplastics and anti-microbial resistance.

At the heart of all this is inequality: inequality in who gets to benefit from progress, and who
bears the brunt of its consequences. On the same planet, billionaires can afford to go to space while billions cannot afford a meal, go to a hospital, or send their children to school.
And yet, humanity has also achieved so much. And though our challenges are daunting, we
can build on those achievements.

In the 1980s, scientists discovered that the ozone layer was thinning because of
chlorofluorocarbons and other ozone-depleting substances. Thanks to activism, research, and
international cooperation, those substances were banned and today the ozone layer is healing.

Also in the 1980s, HIV/AIDS was a death sentence, shrouded in fear and stigma, and I want to acknowledge Dolzura Cortez, the first Filipino to come out as HIV positive. Today, thanks again to scientific research but advocacy, including from people living with HIV, it is a
manageable condition, and people with HIV can live as long as people without, as long as they
have access to treatment. Smallpox, once a dreaded disease that scarred people for life, is
gone. More and more people today are surviving cancer, and there are bright prospects for
better treatments, diagnostics, and cure in the coming years.

Even in the most repressive regimes, there has been resistance, and all repressive regimes
have fallen, resistance has endured. Dictators have been toppled, despots have put behind bars. And thanks to culture bearers and
activists, there is renewed pride in Indigenous heritage, a renewed appreciation for Indigenous
wisdom. I am heartened by the emergence of a multipolar world, of Asian, Latin American, and
African countries breaking free from colonial divisions and forging new forms of solidarity.

We can take part in these efforts, not only as participants, but as leaders. With our collective
experience, we have so much to share with the world. But we can only do so if we give the
planet a chance.

So give others a chance, give yourself a chance, give the country a chance, give the planet a
chance, and finally, give life itself a chance.

Alam ko marami sa inyo, pagod na, at sa loob ng magagarang mga kasuotan, marami są atin ay
may pinagdaraanan. Maybe you have been burnt out by all these years, and even though this is
an occasion for celebration, maybe some of you may not be looking forward to what lies
ahead.

It’s not gonna be easy; it’s not gonna be easier. I think I speak for all your faculty, your parents,
that for me to reach this point from where you are meant facing the challenges that come with
life, from rejection and disappointment to sickness and pain, including perhaps the most
painful of all, the loss of your loved ones. It’s been years since I lost my both my grandmothers and I miss them so much.

But speaking of our loved ones, the people you will miss in life are the same people you want
to live for, so you don’t miss out on them. There are people worth living for.

People like your parents, and those who stood as your parents. your siblings, relatives,
kasambahays, those who worked hard for this moment. We often think of our parents as the
pillars by our side—but don’t you want to be by their side, too, as they grow older?

People like your teachers and professors, the people who the subjects that you took come
alive. Orgmates and teammates, mentors and mentees, the people who you’re fighting for, the
people you’re fighting with.

There are people worth living for.

And there will be moments that make it worthwhile, from something as big as graduating from UP to the small things in life, like a gust of wind that refreshes you on an uphill climb. A sip of coffee that awakens you to a new day. Being with your beloved pets, the Hachikos of your life.
Receiving a message of appreciation or encouragement, from a student, a teacher, a stranger, a friend.

There are people and there moments that make it worthwhile.

So live for your past self who dreamed of this very moment!

Live for that high school kid wondering which course to take. The college student working on their thesis, not sure if they’ll finish on time.

Live for the people you have yet to meet. The people you have yet to love.

Live for the music yet to be composed. The art yet to be imagined. The books you have to
read, the books yet to be written.

Live for the next episode, the next series, the next chapter, the next level, the next stage.

Live for the problems yet to be solved; the discoveries yet to be made.

Live for the races yet to be run, the mountains yet to be climbed!

Once, I was hiking up Mt. Sicapoo in Ilocos Norte, the highest mountain in the Northern
Cordilleras. To climb it, you have to cross Gasgas River several times.

We were already on the way down when a sudden flash flood swept me along the river, and for a hundred meters I was being carried by the current, trying to the dodge the rocks that would
have knocked me out and drowned me.

My life was saved by our Itneg guide, Tatay Emilio, who had the quick thinking to run to the
narrowest portion downriver. With all of my strength, I swam towards his outstretched hand,
and I can still remember the tight grip with which he held my hand, and the tight grip that I also
gave, to hold on and avoid being swept away.

I want you to hold on to life as tightly as I held on to that hand that saved me.

And this, at last, is the lesson I have been privileged to share with you:

Our vocation is life itself. Through our work, through education, research, community
engagement, activism, we can defend life, we can enable life to flourish; we can empower
people not just to survive but to thrive, to realize their full potential, and that we too, can find
meaning, purpose, and fulfillment in our own lives.

And for as long as we hold on to dear life, as long we give life a chance, the possibilities remain
alive, not just for ourselves, but for our country, and for the planet we share.

And so, dear graduates and friends, I say to you “Mabuhay”, not just as a greeting but as a call
to action.

Live! Mabuhay! Live!

Baguio City

July 22, 2025

[Keynote Speech] 2024 Graduation of PGH Residents and Fellows

Keynote speech delivered at the University of the Philippines—Philippine General Hospital Specialty Training Graduation” on Dec. 11, 2024, at the Fleur-de-Lis Auditorium, St. Paul University.

Good day to the faculty, consultants, colleagues, and dear friends: One reason I came here today is to thank you. Your support over the years has been invaluable. Some of you were here when I first set foot in PGH, and it’s been a privilege to witness your growth and careers.

Alongside acknowledging our most illustrious guests, I also want to honor those who cannot be with us, including our heroic COVID frontliners, our mentors, and those who’ve gone before us. To our residents and fellows, if you have family and friends who are not here with you, but was part of your medical journey, I want you to take a moment and spiritually bring them with you; bring your significant others into this special occasion.

My message for you today is simple: resist three things as you move forward.

First, resist comparison. We live in a world of extreme contrasts, where rich kids can spend P100,000 for a dinner in a Japanese restaurant, but poor mothers cannot spend P100 for their kids’ medicines. We live in a world where powerful politicians have billions of intelligence funds but there is always a shortage of funds when it comes to supporting our children’s intelligence. In the course of my travels, I’ve met crypto millionaires, and heirs to untold fortune, who don’t need to work a single day in their lives, but I’ve also met so many people who cannot afford not to work even for a single day, which is why they can’t go to the clinic, or are lost to follow up. 

Closer to home, comparison often defines how we see ourselves and others. You may have felt it in med school, watching high school friends build careers and families while you were still a student. Or during residency, attending weddings or events where your peers seemed to have "more freedom."

In medicine, comparisons are everywhere: publications, H-indices, the number of patients, clinics, awards, recognitions. Even the time it takes to reach a milestone becomes a yardstick for success. Social media only amplifies this, offering polished versions of others' lives and making comparison unavoidable.

But this rests on a flawed assumption: that people can be compared or quantified. How can you compare a year spent caring for a loved one with a year in fellowship abroad? A career in a rural municipality with one in a teaching hospital?

Remember this: comparison is a choice. External judgment only has power if you give it power. You can draw inspiration from others, but don’t let comparisons undermine your confidence.

Having reached this point, you are already among the privileged. Financially and professionally, the worst that can happen to most of you is better than the best that can happen to many others. Embrace the value of your journey, unique and incomparable, just as others' lives are.

By resisting the trap of comparison, you free yourself to find contentment, fulfillment, and true happiness.

Second, resist the inertia of life. Many of you went straight to residency from med school, then into fellowship. Others may have taken detours or entirely different paths. Regardless of your age or timeline, remember: it’s never too late to seek new experiences and embark on new challenges. 

In my own journey, I knew I wanted to be a medical anthropologist even before finishing med school. But that decision meant many more years of study and unconventional choices, leading others - and sometimes even myself - to question my path.

The road has been long: seven years to get an MD, another seven for a PhD, and yet another seven to fulfill my childhood dream of becoming a historian by finishing a master’s in the History of Science. Yet every step, every detour, had value. Along the way, I lived in different places - from Mexico City to Bogota, to Amsterdam to Puerto Princesa, each enriching my life and making me a better person. 

If you’re hesitant about pursuing something new, remember: you don’t need to feel 100% ready. Sometimes 51% is enough. I’ve climbed almost 200 mountains in the country; probably more than anyone else. But honestly, I’ve often woken up for a hike feeling only 60% motivated—but I go anyway, and I’ve never regretted it. 

This applies to your career and your life. If you’ve been dreaming of something—running a marathon, writing a book, pursuing further training, starting an advocacy—take the first step.

One major factor, by the way, is that my parents were very supportive of my decisions, and to the proud parents and loved ones who are with us today: I ask you: Please support our graduates in their plans; give them space, the support to chart their own paths; free them from the weight of expectations. Just as they made your dreams their own, make their dreams yours as well.

Even with your loved ones’ support, it won’t always be easy. There will be rejections, setbacks, delays, along the way. But as Gabriel Garcia Marquez said: “It is not true that people stop pursuing dreams because they grow old; they grow old because they stop pursuing dreams.”

So, graduates, don’t let inertia hold you back. Resist it, and embrace the unknown.

Thirdly and lastly, resist hopelessness. The world can be daunting, filled with crises—political, environmental, and social. In the medical field, we face challenges from corruption to the rise of AI and the threat of future pandemics. At the global stage, it is discomfiting that with a single flick of a finger in your smartphone, you can see images of dogs, and cats alongside images of genocide.

But even in the face of these challenges, we’ve made progress.

When PGH was opened in 1910, life expectancy in the Philippine was just around 35-40 years, but now it’s 71 years for males and 76 years for females. 

Also in 1910, there were 150-200 deaths per 1,000 live births, but when I entered med school in 2005 it was 26 and today it’s 17 or 18.

Just a few years ago, we were at the mercy of COVID-19, but thanks to vaccines and revolutionary progress in making revolutionary progress, we are back to a beautiful gathering like this.

Of course, disparities remain. Life expectancy may have risen, but not for everyone. Kian de los Santos only lived to 17, not 71. How we can even talk about clinical practice guidelines for places where hospitals are bombed, or where, closer to home, health activists are red-tagged? 

Some things have also not changed much. When PGH was opened in 1910, the average height of Chinese and Japanese males was 5’2-5’3 and now it’s 5’7-5’8. In the Philippines it was also 5’2-5’3, and it’s still 5’4. This is not just genetics alone, but nutrition, quality of life. Hopefully there’s nowhere to go but up but we still have a long way to go.

And yet, change can happen on many levels, and you have a role to play in all of them. Structural reforms are crucial, but so are individual contributions.

Yes, we need streets and communities that are inclusive for people with disabilities and chronic illnesses. But we also need rehabilitation medicine specialists, ENT specialists, and ophthalmologists to help patients regain their quality of life. Likewise, neurologists, geriatric specialists, palliative and hospice care experts, are essential to support our growing elderly population. 

Yes, we need UHC. But we also need more physicians in Family and Community Medicine, as well as Internal Medicine, to guide individuals, families, and communities, through their health challenges. We need more oncologists that people can trust so they won't fall prey to those who seek to profit from their struggles. 

Yes, we need all kinds of expertise to expand prevent future pandemics, and finally end the burden of TB, malaria, HIV. But we also need IDS to manage each individual case.

Yes, we must ensure safe and healthy childhoods, with more parks and better schools. But we also need pediatricians to treat children, one patient at a time.

Yes, we need reforms to improve occupational health and safety, and yes, Filipinos must learn to swim to prevent drownings. But we also need emergency medicine specialists, toxicologists, general surgeons, orthopedic surgeons, and anesthesiologists to respond when accidents happen.

Yes, we need to advance reproductive rights, promote gender equality, and address teenage pregnancies. But we also need obstetricians, gynecologists, and specialists in adolescent medicine to care for these populations.

Yes, we need to address the structural and social determinants of mental health. But we also need psychiatrists to provide care during personal crises.

Yes, we must build a society where physical appearance is not a basis for judgment. But we also need dermatologists to care for skin conditions and improve patients’ confidence.

Yes, public health is too important to be left to doctors alone. Yes, we must empower nurses, allied health professionals, social scientists, and patients themselves to take leadership in health. But we also need doctors in public health and more specialists across the country, including radiologists, pathologists, and all the other specialties and subspecialties represented here today.

Hold two truths at once: that health is socially determined, yet also deeply personal.  The lesson of “Kuwento ni Rosario” is not just there were so many interlocking reasons for her death, but also that there were many points where she could have saved. Each patient you treat, each day you improve their lives, is inherently valuable. 

Each of your own life journeys, including the chapter of your lives in PGH, is also inherently valuable. Don't forget to take care of your own happiness, your physical and mental health. 

And what I’ve just told you, I believe, is part of this self-care: Resist comparison. Resist inertia. Resist hopelessness. Instead, embrace the uniqueness of your medical journey. Embrace life as an adventure. And lastly, embrace hope! There is so much we still can do for ourselves, our loved ones, for our patients, for our beloved  country - and for a world that may yet be redeemed.

[Public Lecture] The 59th Dr. Jose P. Rizal Memorial Lecture - Philippine Medical Association

On May 18, 2023, I delivered the 59th Dr. Jose P. Rizal Memorial Lecture of the Philippine Medical Association, in a ceremony held in Manila Hotel. My lecture was titled "Rizal’s Enduring Relevance for Medicine in the Philippines: Nature, Culture, Innovation, and Empowerment" and reflected on lessons from the Rizal's medical practice and way of life that resonate with the experiences and challenges faced by medical practitioners today. The abstract of the talk is as follows: 

Jose Rizal (1861-1896) was an ophthalmologist and general practitioner who, by virtue of his exemplary medical career, is often invoked as one of the pioneers of health care in the country. Less examined, however, is the relevance of the Philippine national hero’s broader ideas for medicine and public health. In this lecture, I survey the life and works of Rizal to identify four major themes - nature, culture, innovation, and empowerment - in which his philosophy and practice hold resonances and valuable insights for the country’s heath care system. Taken together, Rizal’s vida y obra gestured towards a holistic, ecological, culturally-sensitive, and modern approach to medicine: one that viewed patients not as passive recipients of charity but as agents of their health and well-being. 

The lecture was attended by PMA officials and recipients and nominees of the Dr. Jose P. Rizal Memorial Awards including DOH OIC Maria Rosario Vergeire and PMA President Maria Minerva Calimag. Previous Dr. Jose P. Rizal Memorial Orators including Ambeth Ocampo, Michael Tan, Antonio Oposa, Howie Severino, Xiao Chia, among others. 

[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

[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.

[Speech] "Silence is not history": Reflections on historical distortion and disinformation

Speech delivered on the occasion of BALIK KA/SAYSAY/AN: An Online Conference on Historical Revisionism on September 21, 2020.

In “Bamboo Girl” (2016), a short story by the fictionist Ian Casocot, the thirty-something  protagonist explores his mother. lifelong insistence that she came from a crack of a bamboo - like the mythical characters in our folklore. Of course, the protagonist finds out a very different truth, but in the process, he also understands his mother’s reasons for holding on her story. 

“We who are able to tell our own stories own the narrative,” he realizes, adding: “Silence is not history.” 

Casocot’s story comes to mind when I think of history, in light of yet another anniversary of Martial Law. On one level, it points to fact that, as the mother said: “We make our choices in the stories of our lives that we tell”. Of all the moments of our high school days - some embarrassing, many boring - we choose to highlight the most exciting ones, and choose to tell them in ways that make them even more exciting - or relatable. And as the years go by, we add or subtract detail; edit characters in or out; and proofread the past using the present as our style manual. 

Indeed, everyone engages in acts of ‘personal historical revisionism’.

On another level, it reminds us that, like a palimpsest, our nation’s biography is subject to rewriting and erasure. Just as the dictator and his wife successful cast themselves in the mold of the original bamboo couple -  Malakas and Maganda; Silalak and Sikabay - today they have been cast as the regents of a golden age of culture, infrastructure, and wisdom. Indeed, attempts to lie about the past and the present are as old as history. 

Let me quickly give three other examples of disinformation in history. 

When Jose Rizal climbed Mt. Makiling in 1887, he was accused of planting the German flag on its peak as an agent of Bismarck: an early example of what was likely state-sanctioned fake news.

When a cholera plague hit Manila in 1820, panic and fear hit the local and they blamed  the foreigners. “There has been a very shocking massacre of from thirty to forty Europeans of different nations of Europe, and of about eight Chinese, at Manilla.” One missionary wrote. "The perpetrators of this cruel act were the native Manilla people. The pretext was a supposition that foreigners had introduced the disease called cholera morbus, which had prevailed extensively, and was very fatal.”

A third example is much more recent: When a group promised to distribute Marcos wealth to Filipino citizens in 2017, thousands flocked to UP Los Baños - some coming from as far as Marinduque - to claim their share - one million pesos each - of the promised wealth.

Critics being subjected to fake news. Pandemics being the subject of disinformation. Filipinos being promised payment in exchange for supporting for a dictator. What else is new?

Well, what has changed today is that the denialism has become more brazen, and the technologies more powerful to amplify its most pernicious effects. One does not need to watch ‘Social Dilemma’ to see how intense the political polarization has become, how entrenched the ‘fake news ecosystem’ has become - to a point that it is possible to sustain people’s honest-to-goodness conviction that the earth is flat, that vaccines cause autism, or that Marcos is a hero.

Times have indeed changed from the time that Rizal climbed Mt. Makiling, and hardly no one remembers the 1820 cholera plague, except for historians who helpfully remind us of their relevance. 

But the two levels articulated above - the personal and the political - are not unrelated. While most of us are quick to take the view of history as fixed and final, our personal histories reflect that they are dynamic - and such a view doubtless affect how many people view history-at-large. 

And so, a time of pandemic, and in an age where our epistemology is no longer respected, how do we overcome ‘historical revisionism’ - or more accurately, historical denialism? And how do we overcome the fatigue, the seemingly futility, in insisting that a faithful account of past matters?

In the first place, we must ask ourselves whether our history itself has been a form of disinformation. For decades, Filipinos have been educated with Europeans and Americans as reference point, taught that we were inferior, that prior to Magellan we had no history to speak of, and that whatever civilization we have reached is thanks to the contributions of waves upon waves of people of increasing sophistication - from Indonesians and Malays to Spanish and Americans. For decades, too, our history - at least the way it has been taught - has focused on a few people, a few regions. Is this also not a form of disinformation - or at least, a distortion? Is it not also damaging to nation building? Thankfully, the historians and social scientists of today know better and even the balangay has been revived. But the damage of “history as disinformation" remains. 

Secondly - and this will occupy much of my attention in this speech - we must invest facts with an affective quality. Can our history make people feel what it means to be an indio ruled by insulares and peninsiulares? Can we convey the anger of 1896, the fear of 1972, the euphoria of 1986, and the hope, however fleeting, that followed?

The fact that Jose Rizal choose to communicate his ideas in the form of novels speaks of his intuition that reason is not enough. It is not enough to indict the abuses of the Catholic Church at the time - one must construct the character of Padre Damaso. And it is not enough that Crisostomo Ibarra experienced injustice - he must have fallen in love. Rizal’s martyrdom in Luenta - just like Ninoy’s assassination in the airport that now bears his name - communicated what their ideas cannot - and at least for a moment, such events were compelling enough for people to take action.

Ironically, while Rizal recognized the value of affect, he himself has been treated by our textbook in a disaffected way. In the process of requiring Rizal for our students; of apotheosizing him in our historical canon - we have cut him off from an affective bond with young people. Only when I became a doctor and social scientist did I come to truly appreciate Rizal - his mountain climbing, his anthropology, his nation-building project. 

On the other hand, when we consider Fernando Poe Jr., and how his ‘death’ in his films evokes grief and anger among early cinema-goers, we see the power of this affective quality. His films communicated a truth that no political career could ever match: his relatable underdog-ness, and the goodness of his character.

Similarly, Rodrigo Duterte entered people's consciousness as a folk hero, which I believe continues to explain his appeal. Long before he ran for president, people have been hearing of his acts of kindness - whether imagined or real - from disguising himself as a taxi driver or traffic enforcer - to giving aid in times of disaster. Faced with a sense of historic injustice, people saw his own brand of injustice as justice. Duterte also understood the power of symbol - from the kulambo that communicated a simple life to the broken shoe that could dispel - more effectively than all the SALNs combined - the existence of hidden wealth. 

As for Ferdinand Marcos, he was also a master weaver of narrative, faking war metals and manufacturing the story of Yamashita’s gold, which is so effective than until now, it lives on, able to drive people from as far as Malabon and Marindique to the grounds of Los Baños. The gold may be fake, but people’s hopes on it were real.  

This brings me to the point I would like to emphasize: the role of creativity, the role of literature and arts. If empiricism and logic - if documents and testimonies, of amount of billions stolen, are insufficient, then we need to locate history within people’s affective realms for it to matter. 

In other words, we need to create a “cinematic universe” out of our history - one in which it is impossible to mistake Sauron for Gandalf, one in which people can relate to the characters, one which contributes to a sense of nationhood by reflecting and reinforcing our shared experiences. 

In fairness, and much respect, to our artists, directors, scriptwriters - they have tried. We have films like Respeto and Ang Panahon ng Halimaw documentaries like Aswang. And of course, music - like that of BLKD. We only have to remember the late Carlos Celdran to realize the value of performance and richness of our cultural history as a resource for such. 

But have we maximized this resource? If we had the clairvoyance in 1986 to see the events of 2016 onwards, would it have been changed how we treated Martial Law and its many unsung heroes in film and TV? Would it have have placed different words in Heneral Luna's mouth? Can we imagine Liza Soberano as Lorena Barros?

As J Neil Garcia rightly observed, even myths can “animate the character of our national reality”. For as long as Lam-ang remains relegated to textbooks, he will not reach the level of Black Panther in our imagination. Art can breathe life into history, while history itself can breathe truth into art. 

And so as we continue to grapple with an age of disinformation,  I would like to raise the affective possibilities that lie in our history. Historians rightfully warn that such projects carry the risk of distortion, but, whether we like or not, our history being distorted - the question is how do we respond. 

Of course, such projects run into the conundrum of popularization, of the need for “public engagement” - especially in our time when even TV networks are playing second fiddle to social media and its rising breed of influencers.

One things going on our side, however, precisely because criticism is natural for artists, scholars, journalists, and concerned citizens - many of us remain committed to historical record, and open to scientific evidence wherever it might lead. From 2016 onwards, a growing awareness of the existential threats faced by our democracy has led to a sense of community  not seen since the 1980s.

Another is the possibilities afforded by our age is the very platform we're using to make this event possible: the Internet. Yes, we have been on the receiving end of its dark side. But there may yet be emancipatory possibilities that we have not discovered. But the “influencers” of today, many of them young people, are reaching their generations in ways we never can, and some have used their influence to make known their politics. Even celebrities - untethered from their networks - are speaking out. Just as Rizal used the novel to communicate his ideas, we may yet see new media serve as platform for change - whether to get people to vote to stem the tide of disinformation.

To maximize these opportunities, the collaboration between scholars and artists has never been more critical. Unfortunately, our unnecessary divisions - institutional, disciplinal, regional, linguistic, and otherwise - have existed long before the arrival of a divider-in-chief who won by a minority of votes. 

This collaboration should not just multi-disciplinary but inter-generational. Our young people need mentoring. Our elders need coaching with the new technologies. We must reach out to people older and younger than us if we are to serve as generational chains. The idea of mentoring, alas, has faded in light of a commodified education system. But we can bring it back. Can. we challenge ourselves to have at least one intellectual sounding board representing every decade?

Finally, it has to be inclusive. Reducing Martial Law as a dualism between the Aquinos and Marcoses excludes people who do not identify with either. Reducing our country’s history to events that took place in Tagalog-speaking provinces excludes people for whom Tagalog is second language. Reducing our pantheon of heroes to mostly-male illustrates and mostly-elite presidents excludes women, indigenous peoples, and many others. Local histories can bring about a sense of dignity and responsibility - but we need to support state universities, our educators, and the patronage politics that afflicts our educational system. 

Of course, we must affirm the dualism between indelible truth and outright lie. Even in this post truth age, fact checking has forced presidents like Donald Trump and Rodrigo Duterte to retreat in their unfounded claims - from fake cures to false hopes. Even in this post truth age when money can help buy elections through social media - we have seen a woman rise from relative obscurity to defeat the dictator's son. Contemporary rebuttals will also speak louder than future corrections - so thank to our journalists for the critical reporting. 

But we also need an openness to various narratives - like the mother who insists that she came from bamboo. It is not enough to have a villain. We need heroes too - not just one, but many. If we are to build a cinematic universe out of our history, we have to bring out the diversity that is already here to begin with.

Let us bear in mind that, if, as in Casocot's story, “silence is not history”, then we must not tire of our raising our voices. We must not get bored with our own stories. Because our tyrants rely on our amnesia to escape accountability, memory itself is a form of resistance. Yet we must find new ways of retelling. If Darna can be recast and remade, surely we can remind people of the real-life heroes whose only superpower was courage. 

I will end by offering a sigh of relief - or perhaps even a modest declaration of victory. We have made it this far. In the middle of a pandemic, in the autumn of the dictatorship, we are talking about historical record, striving to find a common ground that is big enough to build a country. The very fact that we are having this conversation is hope enough for us - at least enough for us to persist in this project of affirming our right to history - one that is true, one that is inclusive, one that can change people’s minds and just as importantly, touch their hearts.

Gideon Lasco
September 21, 2020

[Speech] Realizing social medicine, revolutionizing health for all Filipinos

Keynote speech delivered at the National Medical Students' Conference - August 8, 2020.

My beloved colleagues, dear friends, students of medicine, fellow learners and fellow Filipinos, good morning to all of you. Let me begin by acknowledging that we are in the middle of a crisis - one that is biomedical as much as it is environmental, social, economic, and political. By all measures, and despite the costly sacrifices we have made in the past several months, the virus remains out of control, and our health care system has reached its breaking point. 

I also acknowledge that on top of this unprecedented emergency, I know that many of you are facing academic, financial, and mental struggles as a result of the pandemic. Some may not even know how the school year will be carried out; how your training can continue. Truly, many emotions cloud our minds today - from uncertainty and sadness to boredom and anger. 

But this is all the more reason why I would like commend the organizers for persevering in putting together this conference. I don’t know how many Zoom meetings you attended, how many virtual work sessions you went through, but I congratulate you for mustering the strength to push through with this important activity. I also thank all the participants for joining us today, whether you are in your homes with your family, in your apartments by yourself, or in the callrooms of our hospitals as among our frontliners. I salute all of you, and share with you the determination to continue our work and advocacy. 

 In fact, the pandemic has made the theme of this year’s conference more relevant than ever. 

 There is no tougher exam than the pandemic -and there is no samplex for it. Incidentally, exactly ten years ago this very day, also on a Saturday, I was in UERM taking the board exam and there was a question about effect of sulfur inhalation in the lungs, leaving most of us completely clueless. Luckily, I actually experienced being surrounded by sulfur fumes while climbing a volcano in Indonesia, and from the sole basis of that experience, I ended up with the right answer: wheezing and shortness of breath. 

 Unlike the most difficult exam, however, where there is ACTUALLY a correct answer - at least most of the time - we do not even know if our answers for the pandemic are correct. Should face shields be recommended - are they effective, and are they cost-effective? Is 1 meter physical distancing enough? Are rapid antibody tests a good use of our dwindling resources? Even our best doctors don’t really know for sure - and you may have seen your own professors engage in passionate debates in social media to litigate some contentious points. The fact that the DOH, CDC, and WHO all changed their recommendations about face masks means that they are likewise facing this lack or certitude. Science, as we have seen in the past months, is neither definite nor independent from social and political influence. We are learning to be critical the hard way - but even all our criticality put together cannot constitute any certainty as what lies ahead of us. 

 Despite the fact that we do know enough, we soldier on, in the same way that our predecessors in 1918 faced an unknown illness that would come to called the Spanish flu pandemic, a pandemic that claimed the life of my great-grandfather, Silvestre Diaz, in San Pablo Laguna alongside 80,000 other Filipinos, and millions around the world. Lest we forget, Dr. Jose Rizal volunteered his medical services for Cuba before his martyrdom in Luneta, even if it meant being on the side of the Empire has had criticized. Lest we forget, interns and residents kept the Philippine General Hospital running even in the bloodiest moments of World War II - with 27-year Honorato Quisumbing losing his life in the process. 

 Thankfully, not all pandemic-related questions are unanswerable. Not all pandemic-related issues are medically contentious. And not all pandemic-related facts are equivocal. We know from the experiences of other countries that the more testing and contact tracing we do, the better we can control the pandemic. 

We know from our experiences with HIV and TB, that fear and shame will only make it harder to test and treat people, while adding social and emotional pain to their illness. 

We know from the failures of the so-called drug war, and from the experiences of those living and working in communities both urban and rural, that a public health crisis requires a public health - not a military, not a police, and not a punitive - response. 

But adding to our frustration is the fact that even if the answers are very clear, it is the incorrect answer that informs many of our policies and programs. People who need testing have been denied testing, even as people who simply desire it are granted their wish with much faster results. People who test positive are threatened with shame campaigns and treated like criminals, even as law enforcers who flout the law are given a free pass. Low income households and communities - already more susceptible to disease by virtue of poor nutrition, and more vulnerable to infection by virtue of their work and living arrangements - are further encumbered by misguided policies that hurt more than they heal. 

 All of the above are making us realize the urgency of the topic at hand, which is social medicine, and the ‘revolution’ that a move towards it entails. 

 So what is social medicine? Just like ECQ, GCG, and mass testing, we need to define our terms carefully. Personally, I consider social medicine not as a separate field or branch of medicine but as a framework that broadens clinical concepts such as “diagnosis” and “treatment” to include social, economic, and political pathologies. It views people not just as patients in need of cure, but as people with knowledge and agency with whom doctors must work to attain the well-being not just of individuals but of communities and nations. 

I would like to break down this framework of social medicine into three functions - bridging medicine and society, bringing medicine to society, and bringing out the “social” in medicine. 

Bridging medicine and society

The first is bridging medicine and society, that is bridging people’s experiences and knowledge of health and illness with our biomedical knowledge, facilitating understanding of both sides.

 For a long time, clinical medicine rested in the assumption because diseases were an objective reality, we didn’t really need the patient’s words - except in aid of diagnosis, and even them, symptoms were seen as inferior to signs. The laboratory tests told a truth that no clinical history can match. If one can see a Ghon focus on chest X-ray, and have a positive sputum smear, it didn’t matter where the patient came from. As long as they take medicine for 6 months, you’ve done a great job. 

 Of course, even then, intuitively, clinicians knew that they had to win rapport - a charismatic doctor is more likely to convince a patient to take the medicine for 6 months. A family-oriented doctor is more likely to get the patient to take the medicine for 6 months by motivating his wife or husband. And a community-oriented doctor is more likely to get the patient to take the medicine by understanding the barriers to care - perhaps the clinic is simply too far. 

 But this was not emphasized in medical school, which drew on an objective reality as its epistemological paradigm, confining itself - at best - to the interaction between the doctor and the patient in aid of diagnosis. 

What goes on outside the clinic is none of the doctors’ concern - as long as the patient complies with his orders. 

What the patient says is none of the doctors’ concern if it does not align with his own clinical understanding. 

 What’s happening to the environment - from the movement of animals to the decimation of our forests- is also none of doctors’ concern unless there is a clear association with a disease. 

As a result, despite the breakthrough discovery of antibiotics and vaccines that have saved millions if not billions of lives and made many people in the 1960s optimistic that medicine can actually end disease and suffering, medicine has not been very effective in reaching its goals. 

 Let me give you one example. In a not-very-well-thought-of measure, doctors in the 1980s tried to euphemise tuberculosis by calling it “mahina ang baga” - instead of educating people about stigma and aggressively dealing with TB. What happened to “mahina ng baga?” 

 Well, to maintain the fiction of “mahina sa baga”, doctors could not tell patients that they needed medicine, because, based they were not supposed to be sick. So how did they call Isoniazid, Rifampicin, Pyrazinamide, and Ethambutol? 

Vitamins sa baga. 

 And what did people do with vitamins? They used it as vitamins - only when they have symptoms, only when there’s a health threat, like today’s pandemic. Needless to say, this whole “mahina sa baga” discourse has been undermined the entire TB program, and today we continue to struggle with a disease that is still on track to kill more Filipinos this year than COVID-19. 

A social medicine framework tries to bridge the doctors’ knowledge and experience, as well as those of the patient, through the recognition, first of all, that local knowledge matters.

 The case of “mahina ang baga” points to the fact that biomedical knowledge often gets lost in translation.

The case of tu-ob is also illustrative. When Governor Gwen Garcia of Cebu recommended tu-ob as treatment for COVID-19, it invited ridicule and rebuke, to some extent justifiable, from health professionals. But tu-ob makes sense from the perspective of people’s ‘explanatory models’ or ‘folk physiologies’ or how they understand the workings of the body. To start with, it is not accidental that the word baga means both ‘lungs’ and ‘embers’ in local languages including Tagalog, as in sunog-baga, nagbabagang apoy, nagbababagang balita. Lungs are seen as embers of the body and as a “hot” and “dry” organ. Thus, anything that that’s cold and wet is seen as pathogenic, which is why people are anxious if they are ‘nalamigan’ or ‘naambunan’. 

Thus, masseurs will insist on removing the ‘lamig’ in your back as they might enter the lungs, which, when melted, is seen as explanation for phlegm or plema. 

Conversely, anything that’s warm is seen as therapeutic for the lungs. For a long time, smoking cigarettes is seen as therapeutic, and this is actually an idea shared around the world - even the young asthmatic Che Guevara received some a special kind of cigarette as an asthma treatment. Hence, it’s very easy to convince people to nebulize - you don’t have to convince people that nebulization works because it goes along people’s folk physiologies. 

Hence, people are sympathetic to therapies like ‘tu-ob’, also known as ‘saab’ or ‘luop’. Such realization, of course, will not change the fact that ‘tu-ob’ does not cure COVID-19. But if we understand where people are coming from, they we will be more respectful and effective in our response. In my own research, I have explored notions of blood in relation to hypertension and found that ‘high blood’ is seen as a function of blood viscosity - malapot or malabnaw. One implication is that because anemia is seen as malabnaw while high blood is seen as caused by malapot na dugo, many patients think you can’t have both anemia and hypertension at the same time, which of course is not true. 

So yes, local knowledge matters, and we also see it in disease outbreaks such as SARS to COVID-19. Local notions of ‘hawa’ and ‘resistensya’, as well as concepts of ‘loob’ and ‘labas’, affect the decision on what vitamins and food to consume, whether to use face masks, and when to do physical distancing. 

Aside from local knowledge, words also matter. Our choice of words matters if we are bridge the gap between doctors and patients - and between public health and the public. Also, understanding people’s choice of words matters if we to connect to them. Words give form and shape to our realities, which is why many words cannot neither be translated nor fully understood apart from the culture in which it is used. For example, words like “kilig” and “sayang”. 

 In medicine, we tend to quickly translate words without trying to learn from them. Sometimes, patients are too embarrassed to use their own terms. However, words have value in themselves: To respect patients’ words is to dignify their narratives; to take those words seriously is to be a better doctor 

One peculiarity of our local languages is that words that have similar meanings tend to share the same root. So when people say “hingal” and “hingalo” people usually mean something that’s pulmonary, whereas hapo is cardiac. We need more studies to explore symptoms using patients’ own words. 

Finally, symbols matter. Everyone knows that the stethoscope is a symbol of medicine, but not everyone taps into the power of this symbolism. If we view the stethoscope only as a tool for diagnosis then we will only auscultate when needed. But if we view stethoscope as a symbol of listening to one’s patient and reassuring the patient that you listened to their body, then you will auscultate. 

Bear in mind that before the invention of the stethoscope, doctors actually put their ears on patient’s chests to listen to their breath sounds and heart sounds. Do we also listen to how people understand their conditions? At the heart of social medicine is recognizing that just because something does not exist in our textbooks doesn’t mean that they do not exist in the lived realities of our patients. As Che Guevara once said: “We should go with an inquiring mind and a humble spirit to learn at that great source of wisdom that is the people.” 

Bringing medicine to society 

I just talked about how social medicine bridges medicine and society by seeking an understanding of both, and explaining one to the another. 

 Secondly, social medicine also strives to bring medicine to society - and make health - not just health insurance, not just free medicines - available to everyone. In other words, social medicine recognizes that socialized medicine is not enough. 

If what I just said sounds lofty and high sounding, that only goes to show how jaded we have become. And I understand. Who wouldn’t, in light of the obscene corruption in PhilHealth? Just like some of you, I have been in an ER triage where your residents tell you that you have to turn a patient away, despite the desperation in their faces. Today, we see so many people struggling to find a ward or a bed willing to accept them. Our health care has been “covidized” - we want to deal with a pandemic but many other illnesses are being sacrificed. As applied to COVID-19, a social medicine framework uses people’s actual health needs - not political imperatives - as a starting point for policymaking.

Social medicine also recognizes that if we are to bring medicine to the people, then we cannot rely on ourselves - our mistake is sometimes to think that we alone have this burden - and that we alone have the knowledge and expertise. Medicine is too important to be left to the politicians, but it also too important to be left to doctors. 

We need to involve families, community members, including the barangay health workers. In Bangladesh, I have seen how community health workers, sufficiently empowered, can actually make a huge difference in TB programs. Among others, they incentivized their “shastu shebikas” - for every successful DOTS treatment, they will get a reward. And it worked, because they were recognizing the social capital of community members. 

 In Cuba, meanwhile, I saw how a strong primary care - with focus on immunization and prevention - can make a country have better health outcomes than the US - even when their hospitals have fallen into corruption and disrepair. One other strength of Cuba is that they have their own pharmaceutical industry - they even make their own vaccines - giving them resilience in facing health crises. A social medicine approach will also question why we are not able to do this. 

Towards the end of bringing medicine to society, we should involve health psychologists and communicators to help understand human behavior and what messages are most effective. We should involve social scientists to help us explore the barriers to care. Oftentimes, we think that the problem is money alone, but the social sciences can tell us otherwise. For instance, at the height of the dengue vaccine scandal, we have parents saying “I would rather die of dengue than the dengue vaccine.” Where are these sentiments coming from? How can we understand anti-vaxxers, conspiracy theorists around COVID-19? When we say “culture” in anthropology, we do not just mean indigenous knowledge. It encompasses the rapidly-evolving practices, from the use - or non-use - of face masks to the appeal of steroid injections and alternative cancer treatments. 

We can also involve historians to tell us of the lessons of our past. At the height of ECQ, one of the personal projects I embarked on is to write a social history of SARS in the Philippines, and what I have seen is that many of what we’re seeing today have actually been foreshadowed before. What have learned from previous outbreaks? How can we make sure that the lessons of COVID-19 are available for future reference? 

Social medicine, in other words, calls for tapping into our creativity, expertise, and people-centered collaboration to achieve better health. Not just health outcomes that are tangible, but intangibles like respecting cultural knowledge and upholding the dignity of people’s lives and livelihoods. 

Bringing out the “social” in medicine 

Social medicine bridges medicine and society by seeking an understanding of both, and explaining one to the another. It brings medicine to society by interrogating biomedical and neoliberal notions of ‘health care’ or ‘socialized medicine’ and identifying barriers to culturally-sensitive ‘heath for all’. 

Thirdly and lastly, social medicine brings out the “social” in medicine by identifying the social and political pathologies that cause disease and suffering. Social medicine argues that illnesses are socially determined, and that heath cannot be disentailed from environment, economics, and history, even colonialism. 

In one powerful example of a concept he called “structural violence”, the medical anthropologist Paul Farmer narrated HIV/AIDS in Haiti and argued - by a retelling of its history, that we cannot talk about HIV in Haiti without talking about its history of colonialism and slavery; of an uneven globalization that made the country perpetually sunk in debt, at the mercy of its debtors like the US, and chronically poor, rendering its people vulnerable to sex work and sex tourism. Despite a history that implicates colonialism, people ended up blaming and stigmatizing the people of Haiti for HIV in what farmer calls “geography of blame”. 

Another example is dengue in the Philippines. What causes dengue? A virus. What carries the virus? A mosquito. But if we dig deeper, we can start asking questions like, where did the mosquitos come from? Who gets affected the most? Aedes aegypti thrives in stagnant water which rarely occurs in communities with forests intact. In fact, Aedes aegypti became widespread in the Philippines due to the clearing of land for sugar plantations and for cities, with the increased temperature due to deforestation also contributing to increased mosquito bioactivity. So we cannot talk about dengue without talking about deforestation brought about by colonialism, of access to flowing water, of stagnant economies, and of land use as vector of disease. 

Many of you are familiar with ‘Kuwento ni Rosario’, the classic of community medicine, that every medical student - at least in PGH - goes through. When I was in South Africa, I had the opportunity to meet community health organizers including David Saunders, a pioneer of the global primary care movement, and one activity they organized had a story that was very very similar to ‘Kuwento ni Rosario’, which got me wondering if there’s any connection. As in turned out, yes, there was. ‘Kuwento ni Rosario’ was written by Gerry Andamo and community health organizers led by Dr. Delen Dela Paz in early 1980s, after a visit by David Werner, who worked with David Saunders and inspired case studies based on chain of causes or cadenas de causas. 

David Werner was in turn inspired by his community experiences in Mexico, as well as the writings of Paulo Freire, the Brazilian philosopher who called for empowering communities to understand the roots of their problems. 

What can we learn from the ‘kuwento ng kuwento ni Rosario’? 

First, it is harder to look away from a face than from a disease. Every day we are given numbers. Yesterday, DOH reported 3226 new cases and 46 new deaths. But behind numbers real people. If we are to bring social in medicine, we need to tell stories like Rosario’s because while numbers dehumanize, narratives humanize. 

Second, we really cannot tell which of our little acts will make a difference. The people behind Kwento ni Rosario didn’t realize how much an impact the story would have for generations. Don’t underestimate your own stories, writings, community involvement, advocacy work. Maybe a public health lecture, an article you wrote will inspire someone, which will in turn inspire another. 

Finally, the fact that Rosario remains resonant today as it was in the 1980s means that much more needs to be done today - we have not really addressed the root causes, and the same factors responsible for the death of Rosario continue to claim lives today. Social medicine - through concepts like structural violence and social determinants of health - gives us a vocabulary with which to demand reform - and call attention to the chain of causes that underpin people’s health. 

Why 'revolutionary medicine'? 

All of the above might sound good. But why has it not been done? Why do we need a revolution for something that’s seems clear and obvious?  

Social medicine is by nature revolutionary because it goes against the status quo.

First of all, the demands of social medicine are politically inconvenient. It is easier to just dole out ayuda, instead of building health care capacity. The first approach creates ‘utang na loob’ for politicians, the second approach opens peoples eyes to the fact that politicians are part of the problem. It is also safer for doctors to just stick with clinical facts - if they start looking at the problems of government, what Rizal calls social cancer, they will go after you. Pushing for an RH Law or pharmaceutical reforms will earn you enemies - even the “No approved therapeutic claims” at the end of food supplements today was secured at the cost of lawsuits.

Secondly, it is financially inconvenient for many people involved. Regulating the cost of medicines and  medical procedures may lead to lost income, and if there are more doctors, the price of healthcare will go down - alongside doctors’ income. Moreover, strengthening the public health system may also mean lost revenue for the private sector. Are we willing to do this?

Thirdly, it is epistemologically inconvenient. As doctors, we are still trained to view randomized control trials and other 'robust evidence' as the gold standard. Given our training, it is inconvenient for us to take patients seriously. It will require a culture change within the practice and teaching of medicine for attitudes to change. 

Finally, it is symbolically inconvenient. Social medicine entails doctors letting go of our status at the top of the pyramid. Let’s face it, being a doctor is prestigious. We get all the credit for treating patients, and we are the face of healthcare - despite attempts to vilify us. However, medicine has its own authoritarian tendencies, which explains why many doctors warm up to the idea of a dictatorship. Likewise, public health is utilitarian by nature, which similarly explains why many doctors think the ends justifies the means: If building a nation requires cutting the jobs of 11,000 employees, so be it. If having a drug-free Philippines entails the collateral damage of tens of thousands of victims, so be it.

To a certain extent, this is understandable: if you are a surgeon in the OR, you have to make decisions by yourself. You cannot consult your colleagues - let alone the interns and residents by your side. There is no time. Too many decision-makers will only delay healthcare. And if you are an orthopedic surgeon, you know that sometimes you need to cut a limb to save a life. The ends justifies the means. 

Even so, we know that, writ large, this analogy is dangerous: a cell, a tissue, an organ, or even a limb cannot be compared to human life, each one of which has intrinsic value. Moreover, while in certain situations we need someone to make decisions STAT, we still need to make sure that that person is actually competent, and knows what he is doing, and that he is not abusing his authority. 

The surgeon in the OR analogy is also limited because among the consultant, resident, intern, and clerk - it is truly the consultant who has the most experience. But when dealing with people’s health, we do not have a monopoly of knowledge. We do not know what goes on when patients leave the clinic. We do not know the communities’ resources and struggles. And we do not know how to communicate effectively as well as those who actually devoted the same amount of time we spent in medical school studying communications. 

All of these barriers - from political to symbolic - tell us that we cannot just allow the status quo to take its course, no more than we should resign ourselves to waiting for the pandemic to die out - or for a vaccine to be developed. If we are to realize social medicine in the country, we need nothing short of a revolution. 

Conclusion: Realizing social medicine

We need a critical mass of people using a social medicine framework in guiding their ethics, politics, and clinical practice. To go back to Paulo Freire, we need to work towards “critical consciousness” that enables people to understand why we do what we do, why we are where we are, how we are to overcome the things - and people - that are holding us back. 

You do not have to be a full time medical historian or anthropologist to practice social medicine. You can practice social medicine in your clinic when, the next time a patient comes in and tells you that she has “usog”, or “panuhot”, or “na-barang”, your attitude is curiosity and empathy. 

You can practice social medicine in your hospital by insisting that patients be at the center of care. While doing fieldwork in a people-centred hospital in Singapore, for instance, I saw how patients parking is closer to the hospital than those of non-emergency staff, and the waiting rooms have TV screens and tables with power plugs so patients can work and relax while waiting. That’s not just good business - it is dignifying patients’ time, respecting their worth. 

You can practice social medicine in public health by insisting that we use not just one lens in looking at one problem - but multiple lenses, from people's lived experiences to macro-analysis that implicates the pathologies of power that ultimately affect people’s lives, and indicts the people responsible for our health problems. What good is taking health financing course, and writing a masters thesis on how to improve Philhealth, when its executives will just steal our funds? Will you not protest? But at the same time, what good is an outpatient benefit package if people cannot even afford transportation, if clinic hours overlap with working hours? Will you not want to understand how people actually live their lives? 

Towards this end, we can also demand curricular changes that give medical students more opportunities to learn about social medicine, immerse themselves in society, and equip themselves with skills that you need. Isn’t health communications a necessary subject, especially in this age of fake news and social media? Shouldn’t doctors be equipped with an awareness of governance and politics of health, given that we all have to deal with decision-makers and politicians? Should we be equipped with a stronger medical humanities background to help us make sense of illness, death, and suffering? 

Can we not place cultural competency at the same level as the ability to conduct a physical exam? And can we not insist that just as important as interpreting an ECG is interpreting what people mean when they say hika, hikahos, kalos, hingal, hingalo, sinat, lagnat, binat? 

Beyond curricular changes and academic matters, we can make our voices be heard - there are many platforms. (On this note, I would like to commend those of you who are bravely making your voices be heard in social media. You are not alone, and you should never feel alone whether in your medicine or in your politics.) 

While we need to recognize our privilege, we should also not hesitate to use our privilege to advance our advocacies and causes. As doctors, people listen to us - even if leaders don’t always act on what we say. We have made gains in the past - however inadequate and imperfect - from the Milk Code and Generics Law to RH law, HIV/AIDS law, and to certain extent, even the UHC Law. The fact that Duterte himself grudgingly responded to the medical societies’ open letter means that collectively, we have a voice that we can use. 

As for the individual level, we can also realize social medicine for ourselves by broadening our horizons. I have already mentioned the need to look at patients as resource persons, as teachers - and we can do that with every clinical encounter, but with every adventure - even when you climb a mountain you can learn from communities you meet along the way. Simple acts and gestures can also be revolutionary in their own way. One of the things I learned in Cuba about the life of Che Guevara was that whenever he visited factories, he did not inspect them. He took part in the work. When he visited construction sites, he took part in the mixing of cement. What he was doing, with his actions, is the dignification of manual labor. 

I must confess that when I was a clerk I thought that it was beneath us to be told to do “scut work”. Only now do I realize the lessons I could have learned by welcoming such tasks. By pushing a stretcher bed, we are being taught to put ourselves in the feet of our patients and their bantays. By pushing IV meds, and doing all kinds of hospital procedures, we are being taught to put ourselves in the feet of colleagues who we lead and will work with. Ultimately, the only thing that is beneath is is the abandonment of our duty to do no harm; to be role models of health; and to value every human life - whether she is a person who uses drugs, a person with COVID-19, or a person whose beliefs are opposite yours. 

I also mentioned the importance of books in the curriculum, but we can read books on our own, and we can also write books, stories, essays ourselves. Some of our medical colleagues have penned and edited their books - Drs. Joti Tabula and Ronnie Batiuclon and I hope we can have many more such accounts in the future. As I wrote in Dr. Tabula’s edited volume, I wrote: 

“When a future generation looks back…what stories can we provide? What evidence can we offer that we, in the midst of our hospital lives, contemplated about death, cared deeply for our patients, worried about our seniors, and even managed to fall in love?” 

Writing does not just humanize our patients - it also humanizes us in their eyes. As I wrote in the foreword to Dr. Baticulon’s book: 

“In an age where doctors are both idealized and vilified, we need accounts that place them in their rightful place somewhere in between: frail in their nobility, and noble in their frailty.” 

Travel and learn not just from the places but from the people from different perspectives and persuasions. In the Galapagos Islands last December, I saw a fragile ecosystem affected by humans, and realized, more than ever, that environment and health cannot be disentangled, we have develop a more-than-human consciousness if we are to solve the problems of this troubled century. 

In the Rohingya camps, meanwhile, I met refugees with a painful past, a difficult present, and uncertain future. Just as it is difficult to forget Rosario, I cannot look away from the Rohingyas and am currently working with colleagues in Southeast Asia to raise awareness of migrant health issues in the region. 


Finally, in Ethiopia this January, just before the world closed down, I trekked in mountain communities and experienced the shared humanity that should be at the heart of our medical practice: further realizing  that every culture deserves understanding and respect; that every human life matters; and that there far more than unites than divides us. When children approached me, I actually thought that they were asking for food or money. “They just want to hold your hand,” my guide told me. “They are welcome you to your village.” 

Personally, I have found social medicine to be an exciting framework for my work, advocacy, and way of life, allowing me to channel my interests and passions to something meaningful and adventurous. For those of you who are unsure of what kind of medical path to take, please consider joining public health, and I would love to see some of you take up medical anthropology.

But like I said, social medicine is a framework that can be practiced by everyone, clinicians and non-clinicians, doctors and non-doctors alike.  

It will not be easy. There are parental and social expectations, difficulties that will make you think twice - maybe even twice a day - about the very idea of continuing medical school. Some advocacies require perseverance, and although writing sounds easier than going on a 24-hour duty, ask anyone who went through a dissertation and that person would argue otherwise. By being political in my writing, I have found myself in the crossfire. But as Dr. Jose Rizal once told his students in Dapitan, “Knowledge without courage is useless”. 

And so I invite you to discover and embrace a social medicine framework, one that would enhance your career, enrich your life, and allow us to overcome this pandemic. Together, let us bridge medicine and society, bring medicine to society, and bring out the “social” in medicine - towards revolutionizing health care in the country - and bringing, at all long last, health for all Filipinos.

Gideon Lasco

August 8, 2020