The Philippines is not a small country

Is the Philippines a "small country"?

By Gideon Lasco, MD

ST. LOUIS, MISSOURI - Contrary to what many people, including myself, have always thought and believed, the Philippines is not a small country. In this essay, I survey some of the reasons why the Philippines might be conceived as “small” and present rebuttals, informed by the premise that size is relative: like any kind of measurement or measured quantity, it implies a reference point. Thus, crucial to understanding the way we look at our country’s size are the reference points that we have used in our measuring.

A disorted “world view”

Is the country, in fact, geographically small? With a land area of 343,448 square kilometers (higher than the common estimate of 300,000), our country is bigger than Italy (294,140 sq. km), and is significantly larger than Great Britian (229,848 kms). Mindanao alone, at 97,530 sq. km, is by itself is bigger than Ireland., which measures 84, 421 sq. km. The Philippines, moreover, is bigger than North and South Korea combined. Indeed, ranked among all the nations of the world, the Philippines belongs to the upper 1/3 in terms of land area.

So how come there’s a perception of being “small”? One factor that may have skewed our perception of our country’s size is the use of Mercator projection in most maps. This projection - which is literally the most common “world view” available to us - exaggerates the size of countries the further they are from the equator. Thus they depict the Philippines and other places like India and Africa as smaller compared to their actual sizes, while places like Europe, United States, Canada, and Greenland look much larger. This projection, which was conceived in Europe at the dawn of its colonialist enterprise, has consequently been critiqued as “racist”, and though this is most likely just a side effect (there’s really no way to perfectly avoid distortion in maps), now we know better.

Another factor is the refrence point with which we measure our country’s size. Doubtless, we are smaller than the United States - or even just California. But we do not have to use it as our standard. I doubt if the British would think their country as “small”, and neither would, I suspect, the Italians or the Koreans.

Twelfth most populous in the world

A country’s size can also be measured by its population, and by this measure, the Philippines is actually one of the largest countries in the world. With around 100 million people, our country ranks 12th out of over 200 nations and dependencies, making it “larger”, by population, than France, Germany, Spain, or even Canada or Australia. Whenever I introduce the Philippines to colleagues abroad, they are shocked to hear how large the country’s population is.

Population size can help nations project influence in the global stage - and is in itself a marker of power. Long before it emerged as a major economic force, China’s prominence in the world stage drew, at least in part, from the fact that it was - and still is - the world’s most populous nation. There are, of course, problems with overpopulation - which are beyond the scope of this piece. But it would suffice to say we cannot think of the Philippines as “small” by this measure.

Cultural and historical significance

Could it be that we think of ourselves as small on the basis of our perceived insignificance on the global stage? Again, there are many points that belie this view. Just like area and population size, cultural “signifiance" involves a reference point. Have we been comparing ourselves to America? We should balance our regard for Hollywood with the fact that Filipino teleseryes are actually being shown - and admired - in countries like China, Cambodia, Malaysia, and even Zambia in Africa.

Besides, who defines what is “significant” or not? The problem here is that we have been looking at our own country through the lens of others. An American textbook might probably just have a passing reference of the Philippine-American War, but such omission does not deny the gravity and impact of the war. In this multipolar world, we need to assert our voice through art, literature, journalism, and scholarship, and by ourselves, as embodied bearers of our flag. We also need to realise that in many fields, “smallness” is a matter of choice: surely, we can win an Olympic gold if our government makes sports development a priority. As is often the case, all it takes is for us to put our act together.

***

Thinking of the Philippines as a “small country” can foreclose possibilities, and in the process, reinforce whatever reasons people have for thinking that we are “small" in the first place. It can make us feel needlessly “inferior” in the global stage, and can end up becoming a (lame) excuse for hopelessness and mediocrity. On the other hand, our non-smallness has implications, too. In foreign policy, it should motivate us to act with leadership, both in the ASEAN and beyond. Also, we can not use our "smallness" as an excuse to rely on others for security. On a personal level, it should inspire confidence wherever we are.

Perhaps what may be more accurate is for us to think of ourselves as a young country: one whose nationhood is of relatively recent vintage. Smallness is static, but youth suggests vitality, development, and yes, growth. Thinking this way can provide us with the optimism we need to face the challenges of our time.

Indeed, we are not, by any measure, a small country. This realization should make us stand tall as a proud nation among the nations of the world.

St. Louis, Missouri
March 30, 2015

Pantawid-gutom: Negotiating hunger in the Philippines

by Gideon Lasco, MD

TO TIDE OVER, through the sea of hunger from one island of satiety to another: such is the image conveyed by the term “pantawid-gutom”. For people who eat three meals a day, and meriendas in between, it may be a term that we rarely encounter in our everyday lives. But it means a lot for people who regularly experience what it feels to have an empty stomach.

What makes a good ‘pantawid-gutom’? The foremost and most obvious consideration is the ability to momentarily alleviate hunger. Second, it has to be easy to prepare and consume. Finally, it has to be affordable. After all, lack of funds is what keeps most people from buying better food in the first place.

Street foods are perhaps the most common form of pantawid-gutom. Doreen Fernandez surveyed Filipino street foods in the early 90's, dutifully chronicling some of their colourful names: Adidas for chicken feet, PAL for wings, Walkman for pigs’ ears. Over two decades later, these foods have been joined by pancit canton and other ‘instant’ foods such as candies and junk foods. High in oil, simple sugars, and artificial flavors, many of these foods have “empty calories” that do provide some energy, but without nutrients the body needs. Moreover, they have been implicated in the rise of non-communicable diseases like hypertension and heart disease as well as communicable ones like Hepatitis A and gastroenteritis. When people see what they eat as pantawid-gutom, they themselves recognise that these are not the ideal foods for their bodies, but given the circumstances, they would suffice.

Some also use certain drugs as pantawid-gutom. In my own research on the use of shabu (methamphetamine), I found that one of the drug’s desirable effects (for its users) is its potent ability to suppress hunger. This, and shabu’s other effects, such as giving alertness and allowing people to stay awake, makes it a particularly appealing choice for people who have to work all day and night, such as vendors and drivers, among many others. “Rugby” often used by street children, as well as the nicotine in cigarettes can have a similar effect. Much of the discourse around drugs has focused on how they are linked to addiction, peer pressure, and criminality, but often overlooked are the ways in which they are used by people to deal with their physiologic needs and everyday problems - such as hunger.

Who in our society commonly resort to pantawid-gutom? First, the urban poor, for whom access to food is as good as the money they could earn for the day - a “food insecurity” that we commonly express as “isang kahig, isang tuka” (one scratch, one bite). Children are not spared of this predicament, and the impact is particularly alarming: lack of healthy food leads to stunting and future health problems, as well as weak immune systems that contribute to more infant and child deaths.

Second, we have people who have to work for long hours without food. These include construction workers, laborers, street vendors, drivers, and many others. Often, these are people who belong to the informal sector, unprotected by labor laws. Their lack of funds and time to prepare for food impels them to eat just enough pantawid-gutom to stave off hunger until they get home.

Finally, we have overworked individuals - whether in the corporate world, in call centers, hospitals, schools, and various other institutions. They too, sometimes resort to pantawid-gutom to finish their tasks.

Drawing on the meanings of pantawid-gutom, the government named its conditional cash transfer scheme as “Pantawid Pamilyang Pilipino Program”, or ‘4Ps’. While there have been indications of positive results, its wider impact remains unclear. According to a recent SWS survey, 4.8 million Filipino families said they experienced hunger in the past month, representing 22% of our entire population.

***

THE WHOLE NOTION of pantawid-gutom speaks to us of the hunger that many Filipinos experience on a daily basis, and the tactics (“diskarte”) they deploy in order to get by (“makaraos”). Sadly, many of us have been desensitised to images of children sniffing rugby, or families on the streets partaking of pancit canton and whatever else they can find. Moreover, access to healthy foods among people working in different sectors, formal or informal, have oftentimes been overlooked.

The challenge for nutritionists and policymakers is to come up and promote food alternatives that are safer and healthier, but just as accessible and affordable. Admittedly, this is not an easy task, because for food to be “instant” and “cheap”, a lot of nutritional sacrifices have to be made. But we can start with foods that already there, like protein-rich taho (sweetened snack made of soy), boiled bananas, and kamote-cue. In addition, these efforts should go hand in hand with strengthening the agricultural sector to increase yield and lower food prices. Moreover, for people who resort to pantawid-gutom out of convenience, not out of necessity, education about the health risks of an unbalanced diet can go a long way.

As for those for whom there is little choice, we are called upon to show understanding, empathy, and solidarity. Many Filipinos rely on pantawid-gutom - unsafe and unhealthy foods and even drugs - to tide them over, even as the economic gulf grows wider, and the islands of satiety seem fewer and further apart. Rather than be judgmental or indifferent to their predicament, we should examine and act on the circumstances that have led to their chronic hunger in the first place.

Quezon City
February 26, 2015

Manny Pacquiao and the Filipino fear of blood extraction

by Gideon Lasco, MD

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

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

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

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

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

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

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

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

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

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

***

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

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

More than a celebration of love

by Gideon Lasco, MD

Red roses, Swiss chocolates, romantic candlelight dinner dates: Such are the images that we conjure and strive to enact during Valentine's Day. Listen to the radio and even the songs that were played during your JS Prom are brought back to life. This reminds me that in my high school days, "Who's your Valentine's date?" was the question that gave voice to the peer pressure to have someone on February 14.

Oftentimes we accept these things as part of the calendar. After Christmas, the season of giving, comes Valentine’s and the season of love. Then comes the Lenten season, the typhoon season…and we’re back to Christmas again. But what might we gain if we don't take these things for granted? There are different perspectives that allow us to look at Valentine's - and other holidays - in deeper ways.

A political economy approach, for instance, would historicize Valentine's Day, from its beginnings as the Catholic “Feast of St. Valentine” into its present form, and examine how institutions, including industries, have played a role in shaping it. In Japan, for instance, it was large businesses that fostered the tradition of girls giving boys chocolates on Valentine’s Day, and in 1978, Japan’s National Confectionery Industry Association launched the tradition of boys giving back - chocolates of course - on “White Day” (March 14) - month after Valentine’s.

Gender studies would look at how Valentine's Day serves to perpetuate ideologies of gender, that is, societal expectations of what it means to be a man and a woman. In Valentine’s Day “rituals”, the male is the gallant giver while the female the gracious receiver. The “ladies’ man” knows how to make his woman (or women) happy, and the women are expected at their most beautiful.

On the other hand, public health would look at more pragmatic concerns, such as the proliferation of sexually-transmitted illnesses. Some years ago, the Department of Health distributed condoms during Valentine’s Day, which provoked objections from the Catholic Church. Just a few days ago, Secretary Garin encouraged condom use, invoking the rising cases of HIV to give her appeal a sense of urgency. We think of love as the province of emotions and feelings but the blurred lines between love and sex implicate the body - and the biomedical - in thinking about romance.

What can we take from these perspectives?

First, holidays can be problematic, even oppressive, to people who do not have the means to celebrate them in a culturally sanctioned way. The images of Valentine's Day come with a price: the (overpriced) roses, the chocolates, the dinners, and this could be a burden especially to the poor. Will Choc-Nut suffice - or sampaguitas? Our Valentine’s rituals are embedded in a value system that gives preferences and hierarchies to certain categories of things, such as imported chocolates, and particular kinds of flowers.

The gender ideologies at play can cause singles to feel left out, and so might gays and lesbians, as well as those who have lost their loves, for whatever reason. Arguably, in making “couples” visible, Valentine’s Day creates “singleness” as a category that many people may not even think of during the rest of the year.

Second, however, holidays are amenable to change, contestation and resistance. Writing for Time Magazine (Feb 11, 2015), Janice Kaplan spoke of celebrating Valentine's the day after - when the prices of roses are much cheaper, the restaurants quieter. “Love always seems lovelier to me at half-price the next day,” she quips. Others reject the perceived materialism of Valentine’s by exchanging gifts that cannot be bought: singing a song, making a poem or a letter, or preparing dinner for their loved ones. These acts remind us that “commercialisation” merely furnishes us with symbols whose meanings still derive from the relationships themselves - and challenges us to be creative.

Moreover, people do appropriate Valentine's Day to fit their own circumstances and identities. Single people gather together in parties or even “group dates” to celebrate their “singleness”. In modern societies where marriage rates are falling, and where staying single is a growing preference, magazines now trumpet the benefits of being single in Valentine’s while others offer ways to celebrate it as a single person (Huffington Post suggests “Have a great time with friends”). Still others emphasise a celebration of love construed more broadly: for our family, friends, and beyond. For instance, WWF-Philippines, on their Facebook page, exhorts people to “have a big green heart for the planet."

***

Today I passed through EDSA and the billboards, too, pay tribute to Valentine's Day. There are romantic jazz concerts, dining promos in hotels, and invitations to “be beautiful” in this month of love. Even the red SMDC logo of a rising condominium near Shaw was laced with hearts.

But for all our thinking and theorising on what all these means, I suppose that in the final analysis, what would matter more to us is still what would bring the most joy to our loved ones. For someone who expects a bouquet of flowers, a poem might not suffice, unless you agree beforehand that it's a great idea. Thinking about these things, thus, requires thinking together - a call that can be extended to our society at large. One place to start is the mindfulness that there are many ways to celebrate - or not to celebrate - Valentine's Day. Just as there are many ways to love, and many ways to celebrate love.

Manila
February 12, 2015