My Tita Inday died today. A wonderful person who graced our lives when we lived in Brooklyn. I would pick her up in Astoria in Queens at 5 in the morning on Mondays and make our way through the Brooklyn-Queens Expressway and drive her back on Friday evening. Throughout those exceedingly busy work weeks, she stayed with us and cooked unforgettably delicious meals and took excellent care of our first child.

Long before her cancer and her dying made it easy for us to gloss over her failings, I would tell my relatives that the Tita Inday I knew never uttered an unkind nor an uncharitable comment against anyone despite having endured her own share of unfaithfulness, disloyalty, ingratitude. I am grateful I had the chance to tell her last Christmas that I did not have a single unhappy memory of our time together in New York.

We would make our way to northeast Philadelphia on weekends every chance we got to scour the magnificent clearance racks in what was then the largest outlet mall in the US. Most, if not all of her salary went towards thoughtfully made purchases for her family. It made me and my wife very happy to know that she was happy to be with us. We would have been privileged to have let her continue to stay with us but taking care of her own grandson naturally took precedence. Tita Inday had a clear understanding of what duty was all about.

When she was diagnosed with colon cancer, I could not help speculate how easy it would have been for me to screen her in my clinic and how much my other children would have learned from her kindness and how obese my wife and I would have become if only she remained with us but that is the way life is. You make your choices and for the good ones among us, you live your life for others.

Tita Inday was an Assumptionista. Her father was a talented golfer from Bacolod who helped establish one of the first law schools in the Philippines and who was also a successful publisher. Her mother was a prominent leader of the Catholic Womens League in its formidable days. At her wedding, Judy Araneta and Precy Lopez were part of the entourage. My Tita Inday may never have attained the early promise of her bright social stature but at the end of our lives, who really cares?

She was gentle, she was kind, she was generous and she kept her Faith. Rest now, Tita Inday. May we meet again.

Do we physicians practice what we preach? Do we eat little saturated fats, exercise regularly, stay away from nicotine? The average life expectancy in the US is 78 years. It is 70.5 in the Philippines. The difference is mostly due to the scandalously high infant and maternal rates prevailing in our country. In other words, a Filipino physician in his or her 40’s has roughly the same chances of living up to 80 as anyone living in the US. If we could only provide more potable water, vaccinations, inexpensive antibiotics, anti-tuberculosis medications, prenatal care, obstetric support we would be able to live as long as those who reside in Andorra.

What is my point: anyone reading this entry is statistically set to live beyond the age of 75. Of course it would help to lose a little weight, keep an eye out on our lipid profiles, glucose and PSA levels, submit to Pap smears, mammograms and colonoscopies but the important consideration remains that we live lives that are fulfilling and meaningful. How often have we seen nursing home residents with advanced dementia, abandoned by their relatives and totally oblivious to what is going on around them?

It is not simply a matter of living long. What is more important is living well and being able to share our blessings with others. Much like passing the baton in a relay, we must strive to lengthen the lead we bequeath to those who follow us.

If we should preach any particular message, it is that we neither live nor die for ourselves alone.

The topic for the blog rounds this week is why we continue to love the Philippines and what our reasons are for staying.

From a purely material perspective, there is very little to stay behind for. Educational opportunities are dwindling, security is tenuous, wireless internet service is spotty, the cleanliness of bottled water is suspect, gasoline will only become more expensive, there is a looming rice shortage, traffic and its twin children, pollution and waste of time is ridiculous, the beaches in Thailand are less costly, shopping in Hong Kong and Singapore is infinitely better, Haagen-Dazs is more expensive in Manila compared to Tokyo!

You leave our country and find that much of the world has left us behind. You leave our country and your desensitization to poverty and bad governance disappears, you begin asking questions once again. It does not have to be this way and this is the fundamental reason why we can’t leave our country like this.

We need to love our country and give as much as we can because of those we leave behind. We become a nation only when we recognize our responsibility to help these desperate millions of Filipinos who by the looks of it, have no chance to improve their lives.

We need to keep this love for our country burning because we are the last hope, or so must we frame it in these dramatic terms because if we give up and cede our country’s future to all these politicians who have been presenting themselves all these years, then all becomes lost.

We will be telling our children we had a country once.

In a very disturbing development, the Philippine Supreme Court upheld the disqualification of an elected mayor because he is a United States permanent resident as shown by his possession of a green card. In a glaring display of ignorance, the Supreme Court ruled that US permanent residents are deemed to have abandoned and renounced their status as residents of the Philippines.

A few facts rankle. First, the disqualification emanated from resigned and disgraced elections commissioner Benjamin Abalos. While the elected mayor chose to return to his country and participate in rebuilding it, Abalos was busy sealing the deal that would have allowed him a big portion of a $135 million kickback.

Second, the Philippine government strongly encourages Filipinos in the US to send money back home, invest in real estate and business ventures and return frequently as tourists.

Finally, in order to work in the US and become productive Filipinos who can potentially contribute to our country, we need to legally adjust our status by becoming permanent residents. There is not an iota of love lost for the Philippines in this process. Every remittance reconnects us to our communities. Unless our government prefers us to hang around the corner store and drink beer and gin and sell our votes to all these traditional politicians who control the political process from whence they make their livelihoods.

In all seriousness though, I think this is the preference of the government.

It used to be, during the last year of medical training we would be sent to some far flung barrio and we would get “immersed” with what was truly out there. We would treat hypertension with native herbal concoctions delivered with an enormous dollop of patient education, detailing the pathophysiology of the disease and suggest numerous lifestyle modification techniques that 20 years later I now fully realize was a total waste of time.

What Filipino medical students need is a different rotation, to a healthcare system that works. We should be sent to countries like Japan, the US, Cuba, South Africa and learn about methods that work. What is happening is we are producing generations of Filipino medical doctors who are fully aware of the almost-absent healthcare system but are unable to think differently from the reliably failed nostrums of the preceding generation of public health policy makers.

Philippine healthcare system? System denotes order that promotes efficacy. We are certainly not a healthy people. We are woefully malnourished, our diets depend on sodium to acquire a semblance of palatability, clean water is hard to find and the vast majority of the poor are intentionally kept in the dark regarding their healthcare choices.

We Doctors must find it unacceptable that the government places very little importance to healthcare. And this comes about because many politically connected physicians actively co-opt this tragic lack of foresight. We must understand that there is no way for an unhealthy population to rise from dehumanizing poverty and corruption.

What can we do? We all know the situation is not getting any better. We all have our opinions and solutions, most of which will never be heard because we choose to be quiet and uninvolved. It is easier to allow all these wonderful technocrats and healthcare experts to continue charting this disastrous course while we comfort ourselves by participating in medical missions and contributing assistance towards the medical needs of a few unfortunate souls.

It is simpler and safer to be part of the problem.