Question most frequently posed regarding this quixotic return is where my daughters will attend school. Currently, the older two go to a Christian school and the 5 year-old loves to go to the Montessori Academy that my wife and I helped build seven years ago. For now, we are thinking of enrolling them in the same school that my wife attended in Bacolod (a city south of Manila with a population of roughly half a million).

We feel that what was good for us then must be good for our children. We feel that we received an education that adequately prepared us to take advantage of life's many educational opportunities. We felt that we were taught to learn.

The Philippine educational system needs to re-focus on its goals to make it more relevant to the needs of society. Unlike the US where a large part of the budget is devoted to defense, health and social security, the lion's share in the Philippine budget is rightly allocated to paying for the legions of schoolteachers and the maintenance of humble school facilities.

To become competitive, education must focus on the two C's (instead of the three R's)--Communication and Computation. We need to pare away non-essential subjects and determine early on each student's aptitude and establish magnet schools for the basic sciences and arts and music. The importance of physical education needs to be recognized and not overly emphasized. We need to keep students in school from 7:15 am through 4:30 pm. Make them stay in a place with other children their age and let dedicated and caring teachers guide them to read, listen, sing, exchange ideas and compute. This has been the time-tested formula behind the successful systems in China, Japan and Korea.

Learning is a lifelong habit.

Some other thoughts from the strenuous snow shoveling on the first day of spring. I needed to visit my chiropractor-friend yesterday because my back was becoming stiffer and more tender as the afternoon passed. I also started to sneeze and feel achy all over. I went to bed very early last night.

Healthcare in the Philippines is primitive compared to the US model. Hardly any money is budgeted towards the prevention and treatment of diseases but instead of seeing this as an insurmountable problem we need to look closer and determine the amount of resources that we are actually saving. There is a tremendous waste of money in the American model. Philippine healthcare must focus on vaccinations, clean water, proliferation of vegetable gardens and tilapia farms, suppression of cigarette smoking through education and increased taxation, educational campaigns towards the diminution of soda and sucrose-rich-juice-concentrate consumption and the benefits of aerobic exercise. The drug formularies must concentrate on inexpensive penicillin preparations and erythromycin, diuretics and beta blockers, aspirin, ibuprofen, insulin, glipizide, generic Prilosec (omeprazole), anti-tuberculosis regimens and deworming agents. At this point, the government has no business engaging in pharmaceutical research and development. Nor can the government afford to treat citizens with advanced cancers, renal failure and coronary artery disease.

The Philippines is considered a poor nation because a majority of its people live on less than $2 a day. But absent a trillion-dollar-a-year healthcare system, we do not need a whole lot to live decent, productive and edifying lives.

Spent the first day of spring shoveling snow in the clinic parking lot. Guymon needed the moisture badly and in the 2 hours that I spent clearing the 6 inches of snow I thought how lucky the Philippines was in having 80-90 degree weather the whole year round. From an economic perspective, think about the amount of oil and gas that we don't have to convert to heat, think about the many layers of clothing that we do not have to wear, think about the time we can all productively spend outside. One more important reason-advantage why we do not need a tremendous amount of money to keep the citizens contented.

But instead of taking full advantage of a blessing, we have managed to create large problems like squatting which is prevalent in the Philippines. Because of our warm climate, anyone can put together cardboard walls and roofs using indigenous materials and live wherever it is convenient. There is little respect for property rights. Try taking one of those decrepit train rides and you will wonder how many people live next to the narrow tracks. Sanitation is awful and accidents occur frequently and living conditions are atrocious and you would think that the government would clear all these illegal dwellings. Yet because of decades of compromise and opportunism, these squatters have become rich mother-lodes of votes and have become untouchable. Never mind the hazardous and even life-threatening conditions in what are fondly known as "condominium units" underneath bridges just as long as these poor people deliver a solid vote. The steady erosion of property rights results in demoralization among landowners and can you blame a squatter for not caring for the land that is not his own? The common good has been set aside.

The State needs to exert major efforts in relocating these unfortunate people. While the Philippines is not a huge country, there remain large tracts of undeveloped land that may be converted into safe and clean communities that will encourage citizens to become productive.

Leadership requires political will that must enforce existing laws which protect the common good. When there is general failure to demonstrate respect for fundamental rights, leadership loses its mandate to unite the people towards shared goals. The current crop is way too compromised.

Tagalog is the "national language" in the Philippines, spoken by over 80 million people. It remains my principal language and I am strongly tempted every so often to shift to writing in Tagalog if only to better express myself. Not too many in this venue will understand me however.

Thirty years ago, there was a well-meaning albeit misguided attempt to establish Tagalog as the medium of instruction in the Philippines. Instead of facilitating learning, it only made matters worse. Concepts like "atom" and "gravity" became translated into unwieldy 6-syllable German-type compound phrases. Especially in the sciences, there must be very little room for waste.

In order to become competitive in this increasingly shrinking world, the Philippines needs to regain its fluency in English. This was the principal advantage conferred upon us in our fifty years as an American colony. Why and how we lost this advantage is not important. We only have to look at our neighbors and see the great strides being made in China, Korea and Japan to increase fluency in English.

Language is experience. Words and ideas and feelings are slowly added into the national tongue proportional to time and the number of speakers. There is a lot of romance and gentle beauty in Tagalog, not to mention the other major dialects in the Philippines and this is the reason why it is important to preserve our rich literary heritage but we must stay off from Math and science and physics and chemistry.

Again a flashback from my formative years. We would always inscribe each test paper, each page of homework, each essay with the initials at the top of each page, A.M.D.G.--for the greater glory of God.

I am brimming with ideas and I can't wait to talk about the myriad problems that my country has. The Philippines has become a country of young people and at 43 I am certifiably middle-aged. I will not be returning as a dilletante but rather as the distilled product of 12 years at the Jesuit Ateneo de Manila, 9 years at the University of the Philippines for Zoology and Medicine and blended by 17 years of internship, residency and fellowship training as well as private practice in the United States.

Tony Orlando sang "I'm coming home, I've done my time". I hope that I will not regret in my old age that I did not give my dream my best shot. I admire those patients who are at peace with themselves at the end of a life they think they lived to the very best of their capabilities.