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.

Easy entry, this one is. Last summer, while you were all over the world visiting historic sites and gawking at national treasures, I ran for the senate. 90 intense days. I didn’t campaign for one day more, one day less than the prescribed period. I never bought a single vote and I never appeared in a paid television or radio commercial. I spent a little more than a million pesos of my own funds even if the biggest financial consideration came in the form of the lost income in the 100 days of that unforgettable experience.

Can’t say I didn’t have a good time. Went around the country, met many people. Knew it was a hopeless battle but kept on, knowing it was but a beginning.

Looking back, while working in my clinic in Oklahoma once again, there are no regrets. Did the best I could. Somebody needed to put up a fight. Worst mistake in my youth was to give Marcos, Ponce Enrile, Ver and company a free pass. Everyone was simply so afraid to resist.

Can’t say I’d do it all again. I watch my kids having a wonderful time, reconnecting with old friends. My patients are happy and I am no longer working as hard as I used to. We’ll see.

I’ll have a less exciting summer this year, that’s for sure.

It’s close to midnight here and I am rushing this post in solidarity with my fellow Filipino physician bloggers. I guess the longer you remain in this business, the more you realize that we are able to continue practicing in fairly good health solely because of some special grace. I am not old and yet I know of quite a number of classmates and batchmates who have died, contracted metastatic cancer, undergone angioplasties and bypasses, and the like.

While I really should be more conscientious in meeting my health screening milestones (at least an annual lipid profile, diabetes screening, colonoscopy, etc) I have only become more cavalier with time because let’s face it, the time allotted us is truly very short and the more we think we can beat that aneurysm growing in our brains with a monthly cerebral CT angiogram, the less importance we give to why we are alive in the first place.

Introspection as to what this is all about needs to take precedence over finding ways of prolonging life for the hell of it. Some old folk have this nasty habit. Much like those self-important geniuses who devote countless hours musing about the existence of God.

Get over it. We are all patients. Our illness is our inability to fully appreciate the exceptional blessing bestowed to us of being able to leave this world a better place.

I am writing my entry to the blog carnival from Los Angeles. My 4 children are happily visiting their birth country after staying and studying for 2 years in the Philippines. This is just one of the many crossroads in my life.

Living a full life is similar to going on a journey. Medicine was never an end for me. Early on, I didn’t decide on becoming a surgeon or an obstetrician or an infectious diseases specialist. I decided I was going to begin living an autonomous life as soon as I graduated from medical school. I never bothered to apply for residency training in the Philippines because I could not bear the thought of continuing to depend on my parents for financial assistance after going to school for 22 straight years. It was America or bust.

I have always looked at challenges and adversity as opportunities for growth. The county hospital in Brooklyn, NY where I trained had more than a 90% AIDS caseload. Because there were very few US medical graduates willing to take the risk, I was able to receive superior medical preparation that enabled me to take on future challenges with confidence and competence. I trained at a time when we had to draw blood ourselves, wheel patients to x-ray, before the famous Bell Commission reduced the working hours of resident physicians--when it wouldn’t overly bother us to admit 12 patients on a call night and work 48 hours nonstop.

I look back and I am grateful. What would now be considered illegal and cruel punishment turned out to be a very effective way to acquire skills that would be very useful later.

After Brooklyn, private medical practice was a breeze. Because I entered the US on a J visa, I was required to “serve” a medically underserved area for 2 years. Guymon, Oklahoma with a population of 10,000 became home for more than 10 years. When I began, many patients would not even consider a “foreigner” to treat them. I know this because in the course of my stay, many of my patients would confess to this initial reluctance.

I never missed a Saturday clinic in 4 years. My home number was listed in the phone book and because I was available at all times, my wife and I would see up to 130 patients each day. It didn’t bother me that all that action in New York was so far away and that the nearest mall was 2 hours by car in Amarillo, Texas because I was looking towards another crossroads.

I grew up in the traumatic period of Martial Law. I still can’t understand how some people can long for the return of those days. It was terrible because the vast majority of us were afraid to fight for our freedom and dignity as human beings. Even then, I was painfully troubled by the horrible poverty that alienated and destroyed so many Filipino lives. I always dreamt of seeking my fortune elsewhere and return like the Count of Monte Cristo, vastly more prepared and equipped to help change a hopelessly corrupt system and way of life.

We doctors see a lot of dying in our business. This comes with the territory. We are reminded too often that at the end of our lives, it won’t be the amount of money we stashed in the bank, or the number of vehicles parked in our garage, or how many kids we put through Ivy-league institutions…. We should know better, that our brief lives will be measured by the service we dispense to the less-fortunate; and without a map and without a compass, this is what should guide each one of us through these crossroads.

Since the revelations regarding the almost-consummated $135 million bribery scandal, many of our traditional politicians have been in very good spirits. Each time damaging information would be divulged, their personal share in the ever-expanding largesse being freely distributed would appreciate.

Small proof of this would be the many pages of expensive paid advertisements extolling support for the way politics is conducted here, emanating from all these groups of Governors, Vice Governors, Mayors, Vice Mayors, Councilors down to the lowliest ward leaders. Money, meant for education and healthcare and food is flowing.

The rest of us are indignant. We simply want the truth. We want truthful and direct answers. But we are not getting any. The investigations will continue. Many of these solemn and self-righteous scumbags will continue posing and preening. And there will be more “Unity Walks” and photo opportunities celebrating the strength of our political caste system.

The Show will go on.