Notes on Ayurveda in Nepal and India

Observing an ayurveda session in New Delhi, India (Sept. 2012)

by Gideon Lasco, MD

LEH, JAMMU AND KASHMIR - The first step in anthropology is a step back. A dinner conversation becomes a form of ethnographic data-gathering when you cease participating in it solely, but also begin to observe. Sometimes, the problem in “stepping back” is being unable to step in again, and anthropologists are often observers of their own lives, more than those of others. On the other hand, whenever I am traveling, I find the anthropologist's perspective very useful. I am reminded of a friend of mine who is a hiker and a birdwatcher; she says that since the mountains are full of birds, she has no problems in joining my hiking trips; she can also do “incidental birdwatching”, as long as I don't mind her occasional stops.

Perhaps, traveling is much an enabler of anthropology as mountains are of birdwatching, only that I should also slow down a bit. Then, incidental anthropology can contribute as much to my understanding as a deliberate one.

This is how it has been in our field trip, where my classmates and I went to New Delhi to learn about Ayurveda. There were only three days scheduled for the actual “exposure” to Ayurveda, which consisted of meeting with private and public institutions of Ayurvedic medicine. However, I spent three weeks in India and Nepal, and my encounters with Indians of all walks of life broadened my perspective about Ayurveda.

The first South Asian city I visited was Kathmandu. I arranged for a meeting with the Fiipino community there, which mainly consisted of wives of Nepalese men. After exchanging pleasantries and receiving the plea for daing (dried fish) which they sorely miss, I had the chance to ask them about life in Hindi culture. They introduced some realities to me about Hindu culture, particularly the caste system. As daughters-in-law, their sorry role is to cook the food for the entire clan, because servants, being of a different caste, are forbidden to prepare or cook their masters' food. t is also very interesting how the women bring their own beliefs with them. In advising us to visit the Hindi temple called Pashupatinaph where cremations are routinely done, she warned us not to look at the priests, which had a powerful gaze that is sure to cause usog.

What do they do when a member of the family gets sick? Just like in the Philippines, Western medicine is at hand. When I asked about Ayurveda, one of them responded:

Yung Ayurveda, para 'yang kung sa atin, yung mga albularyo, pero sa kanila, big-time. May sarili silang ospital...pero meron din namang mga dyan lang sa tabi-tabi. Effective din daw pero kami, dun kami nagpapatingin sa doktor na parang sa atin lang... (Ayurveda, it's like what we have – the traditional healers – but to them, it's 'big time'. They have their own hospital, though there are also those that you can just find in the corner. They say it's effective but for us, we jus consult the regular doctor, just like in our [country])

Another adds:

Ayurveda kung tawagin, para yun sa mga sakit na hindi mapagaling ng mga doktor, yung mga malala na. Mas maganda daw ang pakiramdam. (What they call Ayerveda...it's for those who have illnesses that couldn't be treated by doctors, those which are already severe. They say that the feeling is good.) 

After our conversation, I tried to look at how the caste system has affected Ayurveda, but I was not able to get specifics. Many writers have written about the caste system as a “historical inequity” but apparently, in Ayurveda this was never a problem. Perhaps this is because this particular health system has co-evolved with Hindu society throughout the centuries.

In Kathmandu, there are several big hospitals, including a heart center, but you could also see Ayurvedic hospitals, clinics, and “chemists”, not to mention occasional advertisements for Tibetean medicine. It would become a foreshadowing of what I would see in India: medical pluralism.

***

ARRIVING IN New Delhi, I saw many more of the 'chemists'. Some sell exclusively  Western pharmaceuticals – at much cheaper prices (I bought two rounds of Azithromycin treatment, at P10/tablet). Other chemists sold both Western and Ayurvedic products, while still others focused primarily on Ayurveda.

After Taj Mahal and the inevitable gems and carpets that were peddled to us, we reached the highlight of our trip: visits to private and public institutions of Ayurveda.

On our first day, we went to a private Ayurvedic hospital – the Delhi branch of a chain of hospitals that from Kottakal, in Kerala. Our host was a scion of the Varier faimily, whose patriarch P. S. Varier established the first Ayurvedic hospital in 1902.

His office was just like any other MD in the Philippines: Framed diplomas, bookshelves full of medical textbooks, elegant interior design. He also wore a white coat, and  a stethoscope hung prominently on a rack beside his table. Perhaps the only thing that would not be found on a Filipino physician's office was a portrait of Dhavantari, the “god of Ayurveda”.

The way he talked was very physician-like: affable, congenial, and knowledgeable. He deftly answered the question of Dr. Gueco, a nephrologist, about side effects, invoking pharmacologic concepts of lethal dose and therapeutic index. Hand-in-hand with his knowledge of Western medicine was his eloquent exposition of Ayurveda, from its history, its eight specialties, and so on.

His manner and conduct; his personality, and his office – very Western, and yet, avowedly Ayurvedic, symbolizes and shows how Ayurvedic medicine try to achieve a “double legitimacy” of their heath care system but applying (or borrowing) scientific (i.e. biomedical) methods of validation. My classmates (and myself) were visibly impressed by this kind of proficiency and fluency in the language of medicine.


The next day, our meeting with the AYUSH Council (Ayurveda, Yoga & Naturopathy, Unani, Siddha, and Homeopathy Council) affirms what I observed in the private hospital: there is a conscious effort to present Ayurveda as professionalized and modern (i.e. Western). There is no mention of the Hindu religion, nor of the mantras that are required to make the therapy a success – a requisite act in traditional Ayurvedic practice. Instead, 14 successful randomized clinical trials on medicinal plants were presented, together with the curriculum for Ayurvedic medicine that is identical to that of Western medicine, including lessons in anatomy and physiology (side by side with “Ayurvedic literature”).

We see, thus, that the medical pluralism of India, elements that fortify the position of the dominant health system (i.e. biomedicine) are borrowed by the other health systems to strengthen their own validity and credibility. The less flattering (at least to the eyes of observers) aspects of Ayurveda, like the prayers, and the side effects of therapy using metals, were glossed over.

Moreover, there is an awareness that whatever Ayurveda is, it must fit within the larger picture of health care in India and elsewhere. Instead of being packaged as a health system that can take care of everything, its exponents highlight its strengths in focused areas, such as chronic illnesses, specifically psoriasis and rheumatism, as well as preventive care, and palliative care. The AYUSH people are very careful not to make claims of Ayurveda as superior to other healing systems. It is as if there is an unspoken armistice of Western medicine, that it will be tolerated as long as long it does not encroach on Western medicine itself:

Patients are free to choose what treatment they want. If they choose Ayurveda, okay. If they choose Western medicine, it's okay also. We do not impose Ayurved. It's up to them. And if we think that Western medicine is better, for instance for emergencies, we also tell them.

Another often-highlighted aspect of Ayurveda is  its “safety” i.e. “no side effects” and “it is all natural” is an attribute of Ayurveda that is oft-mentioned, by laypersons and professionals alike.

In Ladakh, in the Indian province of Jammu and Kashmir, I met several Indians,  from various cities, and I had the chance to  ask them what they think about Ayurveda. An Indian couple, from Mumbai, spoke highly of it. Another couple, from Assam, had a son who was a medical student, and said that they preferred Western medicine, citing its proven safety. But even they acknowledge that Ayurveda has its strengths, like “those hopeless cases”. Moreover, they have personal experiences of illnesses. As an affluent man from Delhi told me:

For our chidren's coughs and colds, sometimes we use Ayurvedic medicines, sometimes, we buy from the chemist. The irony is, I suspect that even we don't give them anything, they'll still get well! 

What emerges from our India experience is the existence of parallel, but co-adaptive professional sectors of medicine, folk and popular sectors that employ elements of both, and patients taking their pick from various “choices”, using their own experiences as guide. “Doctor shopping” becomes more interesting in a world where various developed and respectable health care systems exist; it becomes “health care system shopping” instead.

Observing the reactions of my classmates, and reflecting on my own, two things impressed us: one, the exotic-ness, and its Western-ness of it. Perhaps, in the future of Indian health care, Ayurveda will be indistinguishable from Western medicine, Ayurveda being so Westernized, and Western medicine adopting some of the best practices of Ayurveda.

As for religion, Western medicine was once closely linked with Christianity, but it has since distanced itself from it. I would venture to speculate that as Ayurveda becomes more “scientific”, and as it draws more legitimacy from clinical studies and experimental methods, it, too, will do away with its “excess baggage of Hinduism” whenever convenient; even as Hinduist Ayurveda will continue to appeal to its traditional Indian clientele.

Based on what I have seen and learned in India, then, the success of Ayurveda can be explained in terms of the following characteristics of it, all of which contribute to the claims of legitimacy and validity of Ayurveda:

1. Longevity – The fact that Ayurveda has been around for so long is used to support its claim as a legitimate health care system. It is true that Ayurveda has its origins from the first millennium before Christ, and has been in continuous use since then. However, the idea of an unchanging, timeless system of medicine needs to be challenged. Islamic influence in India, which brought the unani system of medicine, has also influenced Ayurveda, beginning in the 1100s and reaching its zenith during the Mughal empire (1556-1758). Moreover, following the introduction of Western medicine in the 19th century, Ayurveda has gone through a series of adaptations that continue to the present, absorbing the best of Western medicine and developing its own strengths.

2. Claims to divinity – Closely related to longevity is claims to divinity that Ayurveda espouses. Dhavantari, the mythical founder of Ayurveda, is also known as the physician to the gods. The images of Dhavantari in clinics and wards show that this mystical connection is still honored; a large statue of the god adorns the lobby of AYUSH compound in New Delhi. I had the impression that this is something that was not highlighted to us by the people we met, probably since we were outsiders to Hindu culture. But its presence is evident in many places and instances. The revered founder of the Arya Vaidya Sala private institution, in his official biography, is acclaimed not only for his pioneering work in Ayurveda, but there is a short paragraph at the end telling of his commitment to a Hindu dance troupe.

The complexity of India makes it difficult to predict whether the relationship of Ayurveda with Hinduism will continue to be embraced by its exponents in the future. With Ayurveda increasingly validated by science, perhaps there would a wider latitude for it to become more “secularized”. 

On the other hand, by over-embracing the biomedical divorce of science and religion, Ayurveda might undermine the very reason for its appeal in the first place: its holistic approach to health, seeing its spiritual and emotional dimension alongside the physical. Given this, I would wager that Dhavantari's statue in the AYUSH building will still be there when the next batches of medical anthropology students go on their Indian field trip

3. Efficacy – Efficacy is crucial to any medical system, and this can be measured either as perceived by the people, or by an external mechanism for validation, such as the scientific method. Importantly, the latter method feeds into people's perceptions as well, making it very influential, especially in cultures where “blind faith in science” - as Hawking's philosophical perambulations have been described - is prevalent. In my interviews with people, most of them say that Ayurveda works for them, and they cited their personal experiences.

The scientific case for the efficacy of Ayurveda is more complicated, and perhaps this is a project that will take decades to resolve. A PubMed search would reveal mixed results of conclusive and inconclusive studies, although there is a growing consensus that Ayurveda has benefit in particular illnesses, such as rheumatoid arthritis, chronic illnesses, and palliative care. Moreover, herbs and therapies such as yoga and meditation that have long been part of Ayurvedic therapeutics are increasingly validated by Western studies.

The open-ness of Ayurvedic institutions to having its therapies examined under the microscope of biomedicine will ultimately be for its good, allowing it to have both the “double legitimacy” of sacred texts and scientific research, and the reflexivity that will allow self-improvement.

4. Safety –  Doctors and patients of Ayurveda agree that one of the remarkable strengths of Ayurveda is the fact that it has “no side effects”. This reasoning comes from the fact that since Ayurveda draws its remedies mainly from plants and natural products, there is none of the “harmful chemicals” that go with Western pharmaceuticals. This discourse is not unique to India; we see this being played across various cultures where Western medicine and traditional systems of healing are compared and contrasted. In the Philippines, we see this in the “cough remedy wars” being waged between manufacturers of lagundi and manufacturers of conventional cough syrups.

Many critics of Ayurveda have pointed out that its use of heavy metals as therapy is problematic, and the toxicity as a result of such therapies is becoming a  growing albeit poorly-documented problem that is spreading globally as Ayurveda becomes global. As a 2008 report concludes:

A significant proportion of Ayurvedic medicines contain heavy metals and there are numerous reports of heavy metal, in particular lead, poisoning related to use of these products. In patients, both adults and children, presenting with unexplained anaemia, or unexplained gastrointestinal or neurological symptoms, heavy metal poisoning should be considered in the differential diagnosis.  

The doctors we interviewed counter that these side effects are no different from side effects from biomedicine: they are inevitable in the wider scale, but avoidable if proper techniques are followed.

This issue is hard to adjudicate, given the limited number of studies that deal with toxicity from Ayurvedic therapies, and the qualification of what constitutes “good Ayurvedic practice”. What is important to note, however, is the fact that Ayurveda's perceived safety contributes to its popularity.

5. Holism – The approach of Ayurveda to health is no support the body, strengthen the immune system; not to kill the germs. The massages are said to be “very relaxing” and “very comforting”. Perhaps, the function of Ayurveda as a provider of comfort is no different from the hilot sa panganganak, who provides much comfort (ginhawa) to the women after childbirth, something that Western medicine does not have.

6. Adaptability – This is not an external feature of Ayurveda, but as we mentioned earlier, it is a striking asset without which, in all likelihood, Ayurveda would not have survived. Perhaps, this feature is the one that enabled it to achieve longevity and receive validity from both the scientific and the sacred.

In my interviews with traditional healers in the Philippines, I was also able to observe much adaptation, with some healers using cellphones, X-rays, and other technologies; while others take on emergent diseases using their own techniques, and in this way, cancer, dengue fever, and HIV/AIDS falls under the scope of their practice. What is remarkable in India, however, that  this adaptation is done in an organized, not individual scale.

The degree program for Ayurvedic medicine, however, is styled “Bachelor of Ayurveda, Medicine, and Surgery”. Established in 1940, its holders are entitled to practice not just Ayurveda, but also modern medicine. This indicates that early on, the degree of integration has been fairly high in India, which can explain why Ayurveda has attained a degree of sophistication that cannot be said of other traditional medical systems around the world, with the exception of Chinese and Korean medicine, as well as, to a certain extent, homeopathy.

***

In this short piece, I related my experiences and insights on Ayurveda in India. But what of yoga, siddha, unani, and homeopathy? We did not have time to explore these other systems of healing, but surely, they add to the richness and diversity of health care in India. Scratching the surface of it, I am no different from Alexander the Great, who was, as an important part of the Ayurvedic history narrative goes, “very much impressed”.

India
September 2012

Making the most of a delayed flight

By Gideon Lasco

The announcement airline passengers dread the most is that of a flight delay, and though its increasing occurrence has made it almost a given for frequent flyers, it can still be a frustrating experience.

"Attention all passengers: your flight is delayed due to late departure of turnaround aircraft." The announcer says. What a meaningless statement! It's like saying that “Our date in Makati is delayed due to my late departure from Los Baños.” There are no advance warnings, no details.

My worst experience was on a flight to Puerto Princesa just a few months ago. After a nap in what I thought would be a short and smooth late afternoon flight, I peered out the window and could already see the familiar outlines of the Palawan mountains, as well as the islands of Honda Bay.

We were just about to land when suddenly the plane pulled up then turned around! After a dreadful few minutes of silence - enough time to entertain thoughts like “Are we being hijacked?” - the captain made an announcement that the because of the tailwinds it wasn't safe to land, and also mentioned the lack of lights in the runway. It wasn't very convincing - why did he attempt to fly in the first place?

After the hour-long return to Manila, the flight attendant merely parroted her “welcome you to Manila!” spiel, as if it were our destination! The passengers  - offered neither nor lodging nor compensation - applauded such tactlessness out of sarcasm, but the flight attendant, undeterred, kept smiling and uttering more perfunctory phrases before finally apologising for the cancellation.

***

Negative energies, like any strong emotions, can get us carried away. Given the systemic problems our airports face, however, it is in vain to get mad at a flight attendant. It is also probably unwise to declare "I'm never gonna fly with this airline again!”: Given the limited choices in the Philippines, you might swallow your words soon. The fact is that our airports are operating at a level way beyond their capacity, and all the airlines suffer from delays. Only a major overhaul can fix this - and it wont be happening anytime soon.

But what can we do as individual passengers stuck in an airport? As annoying as a flight delay is, it can actually be a very productive time, to work, to learn, and to connect with your loved ones.

Bringing a book is always a great idea. When was the last time you actually read a book? The flight delays can make even Dostoyevsky readable - unless you prefer observing the young people take selfies. E-books, of course, can also suffice, but for flights I prefer the printed book, which doesn’t ran out of battery, and doesn’t get the flight attendants mad during take-off and landing.

Being inside the airport also puts you in a box that is actually conducive to working. Since there is nothing else to do, you can concentrate more on tasks like unfinished reports and assignments. Also, rather than stare at the "Delayed" status of your flight, you can choose to attend to long-delayed tasks, like responding to forgotten emails text messages. Or call your parents and grandparents - maybe even your high school classmates! Think of all people you've been meaning to call or email, but haven't really done so in a while.

One thing that makes a flight delay especially stressful is if you have scheduled something immediately after it. Here, I can offer some practical tips. The earlier in the day the flight, the less likely it will get delayed. During the peak holiday seasons of summer and Christmas, expect even longer delays.

Afternoon flights to certain airports, such as Caticlan and Cagayan de Oro, are particularly risky. The "delayed flight due to sunset limitation" speaks of another problem: the lack of equipment in our smaller airports.

There are lucky days, as when the flight is smooth and when your baggage miraculously appears first in the carousel. As a mountaineer, I consider it especially auspicious when I see the mountains from the air: as the flight takes off from Manila, Pico de Loro, Batulao, Makiling, Banahaw.

But you better be prepared for when things go wrong. On that aborted flight to Puerto Princesa, my seatmates had booked a cruise to Coron that same night and they were understandably mollified at cancellation, which has irrevocably altered the course of their vacation. Another crestfallen face was that of a father who had just missed his son's birthday.

Their images tell us: People's lives and daily schedules matter. We do not care about dancing flight attendants - or fun games. The minimum airlines could do is to honor their commitment, and the minimum the airports can do is to allow airlines to do so. Surely, paying passengers have the right to demand as much. The airport is the first impression of a country, and if the government seriously want to make it "more fun in the Philippines", the airport is the place to start.

***

Finally, the boarding announcement! "You may now board the aircraft at Gate no. 118" A collective sigh of relief fills the air, and people are stirred from their seats.

As you may have guessed, I am writing this piece in the middle of a flight delay. As a consolation, I found one of the rare functioning sockets in the terminal. Two and a half hours was more than enough to write this article, charge my laptop, and do other things besides.

The queue of passengers fills up, and they make a second announcement. I guess it's time for me to stand up and fall in line. But I will not be in a hurry.

NAIA Terminal 3
August 7, 2015

Do we have the right to modify our bodies?

by Gideon Lasco, MD

Recently, Italian neurosurgeon Dr. Sergio Canevero announced plans to conduct the first “head transplant” on a 30-year old Russian man, Valery Spiridinov, who suffers from a rare muscle wasting disease that has left him severely handicapped. In the planned procedure, Mr. Spininov’s head will be transplanted into a healthy body.

Scheduled for 2017, this plan has reignited a conversation about the limits of medical technologies. “Will it create a new human being?” pundits have asked, with bioethicists, scientists, and religious scholars weighing in on the debate. Spirinidov himself has defended his decision, saying that he is volunteering for the sake of scientific advancement.

The head transplant debate may be dismissed as hypothetical or premature, but it strongly resonates with a broader question that is salient for our time: In this age where individuals are increasingly assertive about their rights and their autonomy in questions of their own identity, do we have the right to modify our bodies? How far can we modify our body parts and bodily features?

***

Before doing a survey of body modification in our time, we must recognise that humans have been altering their bodies since ancient times. Lip-stretching in Africa and Central America, skull-moulding in the Middle East and in the Philippines, and footbinding in China, are just a few examples; some - like the wearing of neck rings in Myanmar - continue to be practiced today. Our “shock” over radically-altered bodies should be balanced with the realisation that body modification is as old as humanity.

Contemporary examples of body modification, meanwhile, are at the heart of many current issues and debates. When Olympic champion Bruce Jenner revealed that she is now a woman by the name of Caitlyn Jenner, her announcement was accompanied by a completely-transformed body, made possible by hormones and surgery. Arguably, her transformation - and that of the Philippines’ BB Gandang Hari before her - was as much physical as it was social.

In June 2015, the parents of US civil rights activist Rachel Dolezal claimed that she was a white woman pretending to be black. A majority derided her for her masquerade - it had emerged that she had tanned her skin and curled her hair - but others defended her right to identify with the ethnicity of her choice. Importantly, however, her ability to claim a black identity was made possible by the ways in which she modified her body.

Of course there are more quotidian ways of body modification. Circumcision continues to be a rite of passage for boys in many parts of the world. Teens endure braces for several months or years to straighten their teeth; women and men in many Asian countries are applying all kinds of products to whiten their skin. Men struggle to attain “six-pack abs”, while women undergo regimens of diet and exercise for a slim, curvaceous figure. What emerges from these examples is the body as a source of distinction, aesthetic worth, and personal satisfaction.

Finally there are also instances of body modification for financial gain. In Iran, a person can legally sell his or her kidney for $2000-$4000, and though this is banned elsewhere in the world, the black market for organ trafficking spans many countries and millions of dollars.

The morality of these practices can be very contentious. Even when individuals consent to their kidneys being sold, for instance, critics point out that such a choice - often in circumstances of poverty - violates human dignity. Female circumcision has almost-universally been called a “mutilation” and outlawed in almost all the countries in which it occurs, but some circumcised women have defended the practice as part of their cultural heritage.

These debates are animated by arguments coming from various fields. Some religious scholars assert that the human body is imbued with a natural dignity that must not be tampered with. Medical experts focus on questions of safety and harm. Political economists look at the ways in which body modification practices privilege the rich (i.e. those who can afford to be “surgically beautiful”) while disadvantaging the poor (i.e. those who sell their kidneys). Finally there are transhumanists who assert that humans should embrace being cyborgs as the logical next step in our evolution. The multiplicity of voices speaks of the contentiousness of the body, and its centrality in many of the debates of our time.

***

Perhaps the very limits of technology will set boundaries on what we can do to our bodies. If the head transplant in 2017 fails, then it will settle the debate - at least for the time being. On the other hand, we cannot discount technological successes beyond our imagination. Just as the first heart transplant in 1967 captivated the world, a head transplant fifty years later will surely provoke a similar - if not greater - response. There is simply no precedent, save for the world imagined by science fiction, on the ramifications of such futures.

How far can we modify our bodies? The answer is for different societies to decide. But it is safe to say that the frontier is going further and further, pushed by technology and enabled by a moral milieu in which individual rights are increasingly taking precedence over long-held belief systems.

Perhaps there will come a point when people will collectively agree that enough is enough. Or perhaps we will come to realisation that what is truly “natural” for us humans is the urge to modify ourselves.

Manila, Philippines
July 25, 2015

We ourselves should be tourism ambassadors

by Gideon Lasco

NEW YORK CITY - On a recent trip to Ecuador I managed to convince two backpackers to visit the Philippines. One of them, a medical doctor from the Netherlands, was planning to do a backpacking trip around Southeast Asia but hadn't considered the Philippines at all until I showed her pictures of Coron and Puerto Princesa. The other, a fresh graduate from Germany, had already heard nice things about the Philippines and just needed some convincing. A mountaineer, he was pleasantly surprised that there are lots of hiking possibilities in the country - from volcanoes like Mt. Apo in Southern Mindanao and Kanlaon in Negros to long walks in the Cordilleras that live up to the Department of Tourism’s one-time tagline of “nature, adventure, and culture”.

My interactions with foreigners have made me realize how important personal endorsements can be in the decisions of travelers on which countries to visit. Testimonials can be just as powerful as the best pictures in travel magazines, or the most crisp videos on travel shows, in enticing people to visit. Thus, Filipinos who work and travel abroad - of whom there are millions - are an untapped resource in the government's efforts to boost tourism in the country, especially in light of its target of 10 million visitor arrivals in 2016.

***

It must begin with our being proud about our country. If we ourselves don’t think our country is worth visiting, how can we convince others to come? Of course, we do have our own little complaints about the Philippines - the traffic, the policitians, the slow Internet connection, and an even slower bureaucracy. But then, which nation doesn’t have problems? These misgivings aside, we have to put our best foot forward and show that there is much more to the Philippines than the problems we sometimes tend to highlight.

Next, we must make a convincing case for why visitors should come to the Philippines. That the cost of living is generally cheap, and that most Filipinos speak English, are good enticements. But we must know the best of what our country has to offer, and it will also help if we know what our would-be guests are interested in. Divers have plenty of choices as within the Philippines lies the “center of the center" of world’s marine biodiversity. Those seeking a more cultural experience should discover our heritage towns, like Intramuros, Vigan, Miag-ao, to name a few - or charming locales like Batanes and the many mountain towns in the Cordilleras. Shoppers will enjoy the malls of Manila and Cebu, while nature lovers may be better off heading straight to Palawan or Bukidnon. There are great caves in Samar for spelunking, limestone cliffs in Cebu for rock climbing, great seafood everywhere…even one day out of Manila is enough to take visitors to the lush tropical forests of Mt. Makiling or stunning views of volcanoes Taal and Pinatubo.

Of course, we must be honest about what visitors should expect. Typhoons, for instance, can thrwart planned trips, especially in the wet season. Traffic in Manila can be frustrating. Then there are places that might be risky for foreigners to visit. However, we must emphasize how circumscribed these places are. Moreover, while these considerations may deter a few, most travelers are aware that there’s always a risk anywhere and that it’s part of the adventure of traveling.

Finally, offering continued assitance will go a long way. I told my newfound friends in Ecuador to feel free to email me if they have questions. Having a contact in an unfamilar place can be the final push people need to come and visit. And the information they need is often effortless for us to provide. Surely it will be easy for us to give tips about taxi drivers in Manila, or how to get to Baguio by bus. By accommodating their inquiries, we are already enacting the hospitality that Filipinos are known for.

***

Tourism is not without its criques, and certainly there are many issues that we need to address before we can wholeheartedly embrace it. Though the tourism sector is said to have contributed 6-7% of the country’s GDP in the past years, we must ask whether the profits in tourism have translated to better quality of life among communities within tourist destinations. We must also ask whether tourism has been environmentally sustainable, as in places like Sagada and Boracay that are clearly going beyond their “carrying capacities” during peak seasons.

These concerns notwithstanding, I think we are all agreed that tourism, done responsibly and sustainably, has a great potential in contributing to our country’s growth. More than the economics, tourism promotes understanding among cultures, and this goodwill can doubtless help many overseas Filipinos, as well as our diplomatic standing in general. Finally, we can actually steer tourism in a more favorable way by directing our guests to experiences and establishments that are friendly to local communities and the environment.

In ending, let me attest my conviction that the Philippines is one of the best places in the planet and it has much to offer to visitors from all walks of life. But we cannot solely rely on occasional TV commercials, ”It’s more Fun in the Philippines" billboards, and occasional inclusions in “must-visit” lists by travel magazines to make this known to people around world, especially if we have a more direct way to get them to come. Indeed, if our tourism sector is to grow, we must take it upon ourselves to be ambassadors and endorsers of our own country.