Fight or flight? A medical student weighs between staying in PH or going abroad

by Gideon Lasco

Fight-or-flight response: n. a physiological reaction that occurs in response to a perceived harmful event, attack, or threat to survival.

Sometimes, I feel that we medical students are the most abused breed in the country. Before, our all-white uniforms carried an aura of dignity and prestige. When people find out I'm a medical student, they will express admiration and wish that I'd give them a free consultation as soon as I pass the board exams.

"That's still too far from now, I would always say," adding, jokingly: "If I give free consults all the time, how will I raise a family?!"

Of course those exchanges are light-hearted, but nowadays there are tougher questions we always have to prepare for. Not just the quotidian "What are you planning to specialize in?", but questions that speak of the times we live in.

First: "Are you planning to take up Nursing?"
Second: "You're just end up working abroad, won't you?"

Oftentimes I am tempted to give a vehement "No of course not!" to the first - and an annoyed look at the second, but I try to be polite. Yet should I say no, they would sometimes follow up, "You're just saying that because you're young and idealistic. Let''s see what will happen in the future." Many people expect us to be heroes, but sadly, they judge our profession even there are many things they do not understand.

Coming from a middle class family, my parents work hard so that I can study medicine. The expenses include tuition fees, dorm rentals, books, medical tools like stethoscopes, and of course, my allowance; what makes it heavy for many breadwinners is the fact that it has to be sustained for several years. Indeed, I would likely be still toiling in the hospital long after my high school classmates have graduated and landed on good jobs.

Daily we study, nightly we review. For a single exam, we have to read hundreds of pages, memorize hundreds of terms, and pay hundreds to photocopy lecture transcripts and handouts. It takes a week to do all of those, and there's an exam almost every week. It's been a month since I was last able to go home to my family in Laguna, because I don't want to fail a subject.

We have to bear the foul stench of cadavers and dissect them, inside-out, in the name of learning. Daily, we medical students take the risk of having all sorts of diseases in PGH ranging from tuberculosis to the common cold; from Hepatitis B to flu.

All these for five years. And to specialize, at least three more. Only then can you begin your practice. It will still take some time before patients will fall in line in your clinic.

Yet, I want to become a doctor. I want to learn about the human body and mind, and enter a profession that is both challenging and fulfilling. Being in medical school, I am well on my way in achieving my goal, but the question is: where do I practice medicine?

If being a medical student in the Philippines is hard, being a doctor is even harder. There will always be sick people in need of care, but many of them cannot afford to pay the cost of medicines and medical services. Doctors also have to make a living, and they cannot always render their services pro bono. Patients can go to public hospitals, but with government budget on health being sliced yearly, government doctors feel that their meager salary - after all those years in training - not worth it.

As for choosing private practice, that too comes with its own challenges: If you want to have a clinic or practice in private hospitals, you have to buy bonds or stocks that sometimes amount to millions.

Who then can blame doctors for leaving the country? Or for taking up Nursing?

Flight from the country is a viable option to those who have experienced the difficulties of Medicine. After years of labor, they expect to be rewarded. And in pursuing an opportunity abroad, one can ensure the future of their family.

On the other hand, fighting for the country is also a choice. The fight I speak of is the battle against diseases that plague the nation; both medical and social ills. Having visited communities all over the country, from the Cordilleras to Southern Mindanao, I realize that just one doctor can make a lot of difference. The satisfaction of seeing lives saved, and people uplifted, can make the financial sacrifice worth it.

A less dramatic example of fighting for the country is staying in hospitals that need physicians badly. These hospitals are scattered all over the Philippines, and if doctors choose to stay in their provinces where they were born, it will mean a lot to their people. Finally, highly-specialized doctors who train abroad would also do well by bringing their skills to the country.

It largely depends on the individual. Any profession is a struggle, and one must choose a path in which he will be satisfied. We cannot demand every doctor to make sacrifices, but we have to appreciate those who do. It is unfortunate that the few doctors who remain in the barrios receive death threats, and are sometimes even killed, by powers-that-be who do not wish our people to progress.

Personally, I remain undecided. As I hurdle challenge after challenge in med school, I learn a lot of things: the vastness of human knowledge; the importance of empathy; and the fragility of human life. In time, maybe the path ahead will be made clear.

Fight or flight? With four more years before I graduate, I will wait before making my decision. Surely, it won't be an easy one.

Gideon Lasco
LU IV (2nd year Medicine)
June 13, 2006

The missing ingredient

by Gideon Lasco

I felt very bad last week: I had left all my baon in the bus. It was too late by the time I realized it; I was already in my dorm. Not that I would starve to death without my baon; I could always buy food in the cafeterias and fastfood places in Manila. But somehow, I felt something amiss. Every day, my mom would text me and ask me how my day was. And he would also inquire: “Anak, have you eaten the meals that I cooked? How was the adobo?” 

She was always concerned about my food. Whenever I would come home during weekends, she would cook my favorite meals: beef steak (with onions and green peppers), abodong manok, roasted ribs, and even home-made lasagna. “A medical student like you should eat a lot so you won’t get sick!” she would say. And then, before I return to Manila on Sunday afternoons, she would have my baon ready. Sealed plastic containers, wrapped in newspaper, snugly fit in a plastic bag. “Put it in the ref at once, so it won’t spoil!” she’d instruct. And sometimes, there would be cookies she baked, and fruits like oranges, mangoes, and when in season, lanzones and rambutan. There would even be sauces to go with the meals. She could’ve spent the whole of Sunday morning, before we went to church, just preparing all these! 

The whole of last week, I felt even worse because I had to lie to her. How would I explain the precious loss? She would be mad and disappointed because she does not want me to eat fastfood meals all the time. Personally I could survive a week of Mini-Stop chicken with Tabasco, but there was something special in my mother’s cooking that I could not name, and that something special makes me long for it, especially when I am away from home.  

The only thing I could do was to promise myself I would never lose the plastic bag again. 

***

Now, a week later, I am back in my dorm in Manila. I am glad that I have brought the plastic bag successfully. Carefully I unpacked the goodies one by one, and I placed them in the refrigerator. There were five slices of brownies, one for each day of the school week. There were the meals, and a large guava. 

It was like a basket containing all the goodness of my home. My mother probably felt that I would be homesick throughout the week, and she made sure that even while I’m away, I would never have the reason to feel sad. Dinner was fast approaching, and I contemplated on which meal I would eat first. 

Suddenly, I realized what was missing in my meals last week; what I must’ve surely missed: In every meal; in every adobo; there was my mother’s love. She had me in mind when she bought those ingredients, and cooked them in our kitchen, with the same utensils which were once toys when I was a little boy. Hers were loving hands that prepared each viand, exactly the way I wanted it. 

It was a very comforting thought. Excitedly, I microwaved a serving of beef steak with onions. Soon its aroma permeated the air, and it seemed more delicious than ever. 

Manila

September 2005

Youngblood: The price of hope

by Gideon Lasco
Inquirer News Service

(Note: This was originally published under the "Youngblood" column of the Philippine Daily Inquirer on June 111, 2005)

THIS is a true story. And I am writing this because I want to open other people’s eyes to the plight of some of our countrymen. I write this to fulfill the request of an elderly man of the Manobo tribe who said to me: “Tell them how much we suffer.”

Trying to escape the scorching heat of the sun and eager to try a novel adventure, I decided to spend a week of my summer vacation in Southern Mindanao. I have a classmate there who belongs to the T’boli tribe. His parents are doctors who have ceaselessly worked for the uplift of the tribes. So I flew there (it was my first travel alone) and found myself in the far-flung areas of Sultan Kudarat, villages where electricity is a luxury and cell phone signals are non-existent.

The roads were narrow and rough, the houses wooden and small. We had no mattresses for us; we slept in beds made of bamboo. We took our baths in the “poso” [artisan well] in front of the house, and our meals consisted of the wandering hens and the vegetables planted around houses. Talk about culture shock!

Four languages are spoken there: Cebuano, Ilonggo, T’boli and Manobo. For a time I felt out of place, but soon I could already understand Cebuano, and gradually I got used to their way of life.

Every day we would ride the “habal-habal,” a motorcycle that can carry six persons, to even more remote places where the Manobos live. Even after the ride, which could rival Enchanted Kingdom’s scariest offerings, we still had to hike for an hour to reach the villages. We walked through banana plantations, cornfields and muddy footpaths littered with horse dung.

“Doctora” [lady doctor] Dagang, my classmate’s mother, had started a literacy program in the Manobo villages and we were able to attend their graduation. When we arrived at one village, they were already in their “school” which was actually just a “nipa” frond hut. The smell of bodies that had gone without bathing for some time permeated the air. Some women were clad in costumes — beaded necklaces and belts — but their clothes were tattered and old.

“People here are lucky to have two sets of clothes,” the missionary working there told me. I could see what he meant: the kids didn’t even have shorts or undergarments, leaving their genitals exposed. Their bellies bulged, infested by worms.

They were illiterate, yet they could understand what a smile meant. I played with the kids who were fascinated with my digital camera, something that’s commonplace in Manila but magical in this village.

One kid stared at me with great curiosity, and when I looked at him I saw such pitiful eyes. “What will become of this kid?” I asked myself. With barely enough money to feed themselves and buy medicine, going to school was out of the question.

I wanted to do something. I asked how much schooling costs in the public school.

“Thirty pesos per year,” I was told.

And they couldn’t afford even that?

“They don’t even have enough money for food!” came the answer.

I wanted to support the kid, even with my own allowance.

“Not here,” I was advised. “This place is too far-off. No one will monitor how the funds are spent.”

But I insisted. If I did nothing, I would condemn the child to a miserable life, something that could be averted.

Doctora Dagang took up my cause and asked for the boy. His name was Eldon, and he was 5 years old.

We approached the missionary and asked him if he could help us help the boy. He agreed, saying that the Manobos needed every little help that could be given to them.

We went to Eldon’s house, and I was moved by what I saw. His was a family of eight living in a hut no larger than our bathroom. Delia, the mother, with her five kids and her parents (her husband was already dead). She herself had no means of livelihood.

Through interpreters and gestures we communicated to each other. I was speaking out of compassion and they were speaking of hope. I will send money to them so that Eldon and his siblings can study.

Thirty pesos — less than the cost of three soft drinks — can educate a child, I kept telling myself. Later I can gather used clothes, books, canned goods and soap for the family.

In the meantime, Doctora Dagang said she would send Delia, as well as other villagers, to attend literacy and livelihood programs. And I knew the little help I was offering paled in comparison to what she was doing for them. Still I promised to do whatever I could.

We left the village amid a chorus of grateful voices. We had given them hope of a better life, a better future. The missionary later told us that there was weeping that night. But they were tears of joy from a people who have suffered for so long and who have been forsaken.

Thirty pesos is the price of hope. It is a small price to pay for progress. And I hope there will be many others who will shell it out.

Gideon Lasco, 19, is a medicine freshman at the University of the Philippines – Philippine General Hospital in Manila.

East vs. West: The rise, fall, and resurgence of Asia

by Gideon Lasco

Any history book will tell us that civilization began in Asia, specifically in Mesopotamia. It was there, in that region now known as Fertile Crescent, where the Sumerians invented writing in 3100. The first cities were built in that region, too. Some dispute this claim, saying that the first cities actually arose from the early Indian civilization, in the form of Mohenjo-Daro and Harappa (in modern-day Pakistan). Regardless, we see that these developments occurred in Asia. At that time, people in Europe were still hunter-gatherers. Meanwhile, progress continued in Asia, as civilization arose in China, sometime during the 3rd millennium BC. Soon, they achieved a monarchy, in form of dynasties beginning with the Zhang. This monarchy matured during the Q’in Dynasty, founded in 221 BC. During these times, paper was invented in China. Gunpowder and advances in medicine (the Indians were even able to perform surgery), navigation (the Chinese assembled the largest fleet during the 14th century AD). I need not mention Avicenna and the medical wonders of the Arabs during the Abbasid Caliphate. Asia even had a printing press before 1000 AD, several centuries before the Gutenberg’s press in Germany. Until the 15th century AD, Asia was well ahead of Europe. The shining proof of this is Marco Polo, who was dazzled by the sights of Yuan China, with all its splendor and advanced knowledge (the Chinese used oil and paper money, things which the Europeans were ignorant of). His tales of wonders were simply too advanced for Europeans to grasp, and they took him for a madman.

The question is: What happened? How did Europe (and, its offshoots, US and Canada) manage to overtake glorious Asia? There is no one reason to explain this oft-analyzed yet still-unresolved issue. There are two good reasons, though:

First, Europe was a competitive and culturally-populated scene: China, India, and even the Arab world lived on empires, often unrivaled. Thus, China saw no reason to adopt and maximize its technologies. On the other hand, the countries in Europe were in constant war with each other, and thus they were also desperate in trying to develop technologies. They also had contact with each other, being adjacent to each other, whereas in Asia the Chinese empire was far from the Delhi Sultanate, which is also relatively  For instance, gunpowder was developed during medieval Europe to easily conquer fortresses and castles. The turning point for Europe is its Age of Exploration, which began with Columbus. And why did Columbus and the Spaniards wish for a westward route? To defeat the Venetian monopoly of spices! Thus, the competitive nature of Europe gave rise to many advancements. It is said that war is the father of technology. With Europe’s many wars (the Hundred Years’ War, the Crusades, the Napoleonic War, etc.), technologies were born more prodigiously than in Asia, where the ‘divine’ emperors, already possessing vast lands, saw no reason to improve their military might. Thus, the technologically-superior Europe easily overwhelmed Asian kingdoms during the 18-19th centuries. India with its elephants was no match; the Chinese was forced to succumb to the ‘Unequal Treaties’ since they had no cavalry to match the well-trained European armies. Needless to say, the experience of Europe in navigation has also improved their ships: equipped with cannons, the Asian ports could not hold. This was evidenced in the Dutch and British takeovers of the East Indies.

Christianity, which created in Europe a universal culture carrying Judeao-Christian ethics and Greco-Roman heritage also proved to be a heavy advantage against Asia. People in Europe were not only physically close, but they also had one way of life (with some variations, of course). They had a universal language (Latin) which they used for scientific exchanges; being of similar cultures they interacted with each other, intermarried (all the royal families in Europe are related, one way or another). Thus, they were able to cooperate not only in political alliances, but also in scientific efforts, which ultimately led to the Industrial Revolution. Truly, exchange of information was facilitated; experiences were shared. The Chinese disdained the Indians; the Indians ate pork and revered the cow; the Muslims ate beef and loathed the pork. These cultural differences within Asia proved to be of a great disadvantage. Large but isolated empires fell into the hands of European powers. The Christian ideals emphasized liberties while the Greek tradition emphasized independent thought (ala Aristotle): upon these ideals monarchies were limited (the Magna Carta of 1215) and of course, much later, the French Revolution. Thus, ideas proliferated. In China, people bowed to the Emperor and kowtowed to their parents; in India there were all sorts of religious rituals and proved to be a hindrance to their scientific progress.

Definitely there are other factors. Some argue that geography played a role; there will be various views, none of which can stand on its own. Two major reasons have been presented (and on these two reasons the others will revolve). Summing these two reasons: Europe, since the 16th century, gained an overpowering advantage over Asia because it was a competitive scene and it had a socio-political climate conducive to technological advances. This competitive scene was brought about by its plethora of nations; this conducive climate was brought about by its heritage: Judaeo-Christian ethics and Greco-Roman heritage. An interplay of these factors sum up the major reason why Europe has dominated Asia.

But the 21st century is already being dubbed as the Asian century. Asian countries are no longer far apart; there no longer are emperors that control the people’s thoughts, words, and deeds. The ethics that Europe inherited is available to Asians; if blended with Asian discipline and creativity it can do a lot. Japan has taken the lead in this East-West synthesis, and it is now wealthier than any European nation. Singapore, Hong Kong, Taiwan, and South Korea are following Japan’s lead, and China – the sleeping dragon – has awakened, now controlling a significant amount of world trade. Politically we have China, India, Pakistan, and Israel possessing nuclear weapons;  world economy is dependent on the oil Southwest Asia produces. Information is available to everyone now, and with Asia’s vast resources, it is bound to retake its former place in this ever-changing world.

Manila
October 2004