Seems like every other Filipino adult smokes. We don't have any of the anti-smoking messages regularly broadcast in the US and advertisements for tobacco products are ubiquitous. Anybody can buy cigarettes here which are often sold by the stick in the traffic congested streets.

The government will not curb this national addiction because of the tax revenues that tobacco brings. The media will keep off this subject because of the huge advertising revenues. Smoking prematurely disables productive workers and smoking causes a lot of pulmonary and cardiovascular diseases that our country (which still suffers from endemic intestinal parasitism) can ill afford.

The Filipino worker overseas is the real present-day hero. Why did I suddenly spring this seeming non-sequitur? Because most of the billionaires (in US dollars) in the Philippines today are engaged in the sale of tobacco, alcohol and serve as middlemen in retail trade. These billionaires hardly produce anything at all. They compete for the $25 a month remittance from abroad from nurses who work brutally long hours, maids who get regularly abused and laborers in Muslim nations who are not free to practice religions other than Islam.

Poverty is terrible and I would hate to deprive people who already have so little but we must think of long-term consequences. A lot of smokers in the provinces smoke in order to ward-off mosquitoes. The government should instead assist the people in cleaning up their immediate environs. There remains a lot of land that is unused in the Philippines and there needs to be a master plan in the creation of new self-sustaining communities that will attract people in the congested cities to relocate.

One very important contribution of Benjamin Franklin was the organization of an efficient postal system. This system has turned out to be one of the key pillars in the phenomenal growth that the United States has enjoyed in the last 200 years. Improvements to the system through FedEx and DHL and UPS have resulted in unprecedented profits for these corporations.

We have a very poor postal system here in the Philippines. Mail delivery is inefficient and unreliable. We can only wonder how progressive this country could become if we had Ben Franklin for a postmaster general. Think alone of all the vehicles that congest our already overloaded highways. Many of these trips (legal documents, money transfers, delivery of goods) can be prevented with an efficient postal system. Think of all the savings in fuel, labor-costs, pollution and above all in time.

Why can't we have a good postal system? I hate to go back to the squatting problem once again but if millions of people do not have permanent addresses then it will be very difficult to set-up an efficient system. People need to stay put in a legal address so that the taxes they pay towards their government may be effectively remitted back to them in the form of reliable public services.

If you thought Medicare Plan D was lopsidedly in favor of drug companies then you need to see the Philippine situation. Atenolol is a beta-blocker that has probably been available in a generic formulation for more than 20 years. Atenolol is available as Tenormin and sells for 80 cents a tablet. In the US, atenolol sells for 12 cents a tablet. Oral nystatin is a very common anti-fungal commonly used for infants with oral thrush sells for $7 for a 120 ml bottle. In the US, 120 ml of nystatin would probably cost 70 cents.

Widely available here in generic form are the common antibiotics and a few diabetes medications. A lot of anti-hypertensive medications come only in branded preparations. Drug stores have very little stocks the few times generic equivalents are available. This is a disaster, especially in a country where a majority of the people get by on less than ten dollars a day. People continue to die in their forties from complications of high blood pressure and diabetes because of an inability to purchase medications.

I understand why the biggest drug store chain in the Philippines prefers branded pharmaceuticals (higher profit margin) but why the government cannot import generic formulations from India and Israel does not make any sense to me at all. Just another example of a glaring lack of political will to enforce social consciousness and ruffle the feathers of a billion-dollar drug store conglomerate as well as the behemoth drug companies that profit every single time a Filipino is forced to take a branded product manufactured abroad.

Every citizen needs to feel a stewardship responsibility towards the country. Every citizen must have a stake in a nation's development. The concept of property rights needs to be strictly enforced because without it there will be widespread demoralization and division.

For the longest time, squatters have been untouchable to politicians who need to pander to this vote-rich constituency. Squatting is a felony and this needs to be enforced to effectively disenfranchise offenders. The State has an obligation to relocate these people to places that are healthier and where citizens are more productive. This will immediately result in a net-loss of votes for incumbent elected officials but this is good poltics in the long run. This should discourage just about anybody who wishes to disrespect the rights of others and will ultimately foster a sense of unity towards common goals for the common good.

I arrived three days ago, actually. 34 hours of travel. Still wide awake at 3 in the morning but I am slowly recovering. For the first time my entire family is with me in the Philippines.

In one of my earliest posts, I recalled Buck from "The Call of the Wild". I thought about the old dog again when the sweltering humidity at the airport greeted me when we landed. Now finally with my entire family in tow, I am entirely released.

Big changes invariably bring apprehension. I do not know what is going to happen. Remember "Cast Away"? You never know what the next wave will bring. But I know that when I landed three days ago, my life as I knew it permanently changed. There is a formidable challenge that lies just in front of me and I will see and everyone will soon see just what the Doctor can do.