University of the Philippines in Mindanao Recognition for 2016

Our ethical formation as doctors begins early. My ethics was greatly formed in college. It shaped my ethics in my responsibility as doctor to the society. Earlier this week, I was informed that I am being recognized by my college Alma Mater as one of the Most Distinguished Alumni of UP Mindanao for 2016. Below is what I had to say:

Salamat sa mga nagbigay ng parangal na ito. Pero ano nga ba ang ibig sabihin ng parangal na ito? Para sa akin, ang tanong ay ano nga ba ang puedeng magawa ng isang estudyante ng UP Mindanao 20 years mula ng kanyang unang  enrolment? Opo, 1996 po kasi ang aking student number.

Sa loob ng 20 years, dapat po sana ay graduate ka na. Dapat sana ay tapos ka na sa pag-aaral mo at ikaw ay may trabaho na para kumita at may sarili ka nang pera. Para naman hindi ka na hingi ng hingi ng pera sa mga magulang mo. Maawa ka naman sa kanila kung sa loob ng 20 years ay humihingi ka pa rin ng pera hanggang ngayon. “Ang makagradweyt at makahanap ng trabaho.” Ulitin ko. Ang makapagtapos ng pag-aaral para makahanap ng MAGANDANG trabahong magbibigay sayo ng MAGANDANG sweldo ay HINDI po tinuturo sa UP. Hindi rin po yan ang natutunan ko sa UP, kaya alam kong hindi rin po yan ang ibig sabihin ng parangal na ito.

Noong kami ay nasa PCA compound pa bilang mga estudyante, ang tinuro sa amin ay kung paano makitungo sa ating kapwa tao mula sa iba’t ibang antas ng buhay. Noong kami ay nasa Pahinungod at umakyat ng Diwalwal o sa Boys Town ay tinuro sa amin kung paano pahalagahan ang kapakanan ng iba higit sa sarili. Noong kami ay volunteer sa Eagle Center at binabantayan ang Agila sa Arakan Valley kahit may panganib, tinuro sa amin kung paano pahalagahan ang kalikasan. Noong kami ay dumalaw sa mga komunidad ng Mandaya, Bagobo at Tboli ay tinuro sa amin ang kahalagahan ng ating kultura. Noong kami ay naglakad sa lansangan ng Magallanes at Claveria, natuto rin kaming ipaglaban ang katarungan. Noong kami ay umakyat sa bundok ng Hamuigitan at noong nagsurvey sa Davao Gulf ay tinuro sa amin ang kahalagahan ng pagtuklas at pagsaliksik ng bagong kaalaman. Hindi po PAANO maghanap buhay ang tinuro sa UP.

Ang natutunan po naming ay paano maglingkod sa kapwa, sa kalikasan, sa Diyos at sa Bayan. Pagkalipas ng 20 years, ano nga ba ang puedeng magawa ng isang estudyante mula sa UP Mindanao? Walang iba kundi ipagpatuloy ang nasimulan at natutunan sa UP. Ipagpatuloy ang tamang pakikitungo sa kapwa, ipagpatuloy ang pagtulong sa mga nangangailangan, ipagpatuloy ang paghingi ng katarungan, ipagpatuloy ang pangangalaga sa kalikasan, ipagpatuloy ang pagtuklas sa bagong kaalaman, ipagpatuloy ang pagsulong ng kaunlaran, at ipagpatuloy ang paglingkod sa bayan. Opo, pagkalipas ng 20 years ay hindi pa rin po ako tapos sa pag-aaral dahil estudyante pa rin po ako sa UP. Pero salamat po sa pagkilala sa mga gawaing itinutuloy lamang natin.

At ang pagkilalang ito ay pagkilala rin sa mga katuwang natin sa mga gawaing ito… ang mga taong tumulong sa atin sa komunidad, mga lider ng people’s organization, Civil Society groups, mga nakatrabaho ko at fellow development workers, mga kaibigan kong nagbibigay suporta at panalangin (sana dagdagan niyo ang inyong donations), mga fellow Pioneers (sayang at wala ng UKLAS Mountaineers) mga naging guro ko lalo na dito sa UP hindi ko na po kayo iisa-isahin (pero especial mention kay Ma'am Novero na nagtiwala sa ating kakayahan) at sa mga una kong guro... ang aking ama at ina; ang aking pamilya na lagi kong kasama at higit sa lahat si Bathala.

Daghang Salamat. Padayon…

AMDG... To God be the Glory...

Effective Altruism and the Ethics of Helping Others through Medical Missions

Effective altruism has been a major concern about the ethics of helping others. The discussion has centered on whether the help we offer has the greatest positive impact to the world. It scrutinizes whether the intent to help others is a valid reason enough to use our resources in certain activity. Such is the ethical questions that needs to be addressed by organizations thinking of maximizing their resources to help others through a medical mission. Here are Six Questions that needs to be answered before you organize a medical mission:


1. Is the medical mission the best way to improve the health of the individual and the community at large?
Medical missions are useful when disaster strikes as the health care system is overwhelmed by the situation. Yet, in ordinary times there are existing health services that the government are offering. It might be more effective to help improve the existing health programs and services available in the community to have longer lasting impact in improving people's health and the community as well. It It is better to put your resources to a program that will provide the greatest benefit to most number of people.


2. Is the medical mission needed in the area?
Many medical missions are conducted in areas that do not match the resources available to the needs in the area. One group once went to a depressed squatters area bringing antibiotics expecting many sick children. They found many to be sick with tuberculosis but do not have the medicines for it. Because medical missions often address acute medical needs, the timing and the location are important considerations for this activities. Another location might benefit the most with what you have to offer.


3. Are the recipients the neediest people who need the service?
This question is related to the first. Medical missions are often limited in their resources. It becomes important then to ask who will receive these limited resources? Do we give these to members of the organizations only? Do we invite our family and friends? Do we cater on a first come, first serve basis? Or do we exclusively limit it to the poorest people who needs the help the most?


4. Is the "medical mission" helping the local health system?
Each locality has an existing health care system. In low-to-middle income countries (LMIC) like the Philippines, it might not be as effective as we want it. But are the medical missions we are conducting helping the system or are we competing against them? Check if there are local health centers and health workers in the area. It will be unfortunate to conduct medical missions without their participation. You might miss creating a bigger and lasting impact.


5. Is the medical mission highly dependent on donations?
Do you conduct the medical missions on a regular basis or only when the resources are available? How will this impact continuity of health care to the people? If the reason why the medical mission was done in the area is because medical services are really needed, what does it mean to provide only once in a "Blue Moon" health services to them or only when resources are available? Limited resources is better placed in programs with the greatest health outcomes for all.


6.  Is the group concern with the health of the people or are they just using it as leverage for their own purpose?
What could be the driving force for the medical mission? Some churches have conditions for the beneficiaries, they offer only medical services only after the beneficiaries have participated in a Bible Study by the group. Politicians leverage it for their election. Groups use it to promote their products. Or do they simply want to help improve the health of the most number of people regardless of nothing to gain in return?


Effective altruism does not question the intent of the people to help others. For many utilitarians like Dr. Singer, they question the impact and effectiveness of the help offered. Effective altruism, thus, puts into proper perspective how medical missions can effectively impact the health of the wider-community. Were the resources used properly? But for virtuous doctors, the question really is, can the medical missions effectively help me become a virtuous doctor? Are the medical missions the best venue in forming in me virtues that will make me an excellent doctor?  For Christian doctors, can these medical missions be the best way for us to achieve Christ-likeness? Will these activities form in me virtuous of magnificence? Do I practice generosity?

For in generosity, I am helping the best way I can to a person who needs me most.

Ethics of Privacy and Respect for Other People's Property

I always teach my kids to ask permission before they touch other people's stuff. That is a basic value people learn early in life. So, one wonders if it is morally right for the BOC employees to check the stuff sent by nurses and doctors to their families and friends? 

Can I open this?

The Philippines is one of the top exporter of nurses and doctors around the world next to India based on the IBON data for 2014. The healthcare workers form the largest chunk of OFWs. They work abroad to provide for their families, families that they do not see often. Despite being physically away, these OFWs show their love and care to their family members with the gifts of love they send to them through balik-bayan boxes. As one popular courier tagline puts it "Ipadama mo sayong padala." Every balikbayan box sent is an expression of love from a lonely OFW healthcare worker.

The "expression of love" is ripped open by the Bureau of Customs employees before it even reaches the supposed recipient. Did the people in the Bureau of Customs ask permission from the OFW healthcare worker? Is it morally right to open other people's packages without their consent? Is it ethical to sort other people's property? Is it valid to rip open a "package of love" for suspecting something taxable inside? What happened to people's privacy? What happened to autonomy? What happened to respecting people's right?

Privacy is an ethical issue. Is it morally right to invade my privacy? Privacy is important for several reasons. Privacy is necessary to safeguard the freedom of individuals and groups. People have the right to keep private and personal matters from the public. If people have the right to privacy, it is morally wrong to violate that right. It is unethical to invade other's privacy and personal property. For the same reason, invasion of privacy is against the law. For example, when I go to the mall and the security guard wants to inspect my bag, the guard cannot just open my bag. That would be unethical. The guard would be violating my privacy. That is why, I would have to willingly open the zipper of my bag and allow the guard to take a peek and inspect what is inside. Only because I allowed the guard to check my bag was the guard able to do it. No invasion of privacy occurred.

The government is supposed to safeguard the people's right to privacy, not the one violating it.

However, we also know that privacy is not an absolute thing. We live in a society that requires us to share information to maintain order in our relationship with each other. Going back to our example, I cannot just refuse the guard to check my bag because of my right to privacy. If I do that, the guard can always refuse my entry into the mall. In the same way, the balik-bayan boxes need to have proper declaration from the OFWs sending them. It is the OFWs duty to honestly declare the contents of the package. We understand that the government needs some information from its citizen for it to be able to govern properly and execute their responsibilities well.

There should be a balance between the OFW's responsibility to share honest information and to the protection of it's right to privacy. One is not more important than the other. The government cannot also give lesser weight to either of the two. It would not only be unethical for the government staff to open packages without the owner's consent, the government would also be violating the people's human rights.

Let this not be another addition to the long list of human rights violation of the government to its people. How can I teach my kids to respect other people if they do not see their government respecting people too?

3 Reasons Doctors Do Not Join Medical Missions

I often get invites to join medical missions. But as a public health practitioner we know that short term "Band-Aid" solutions are not enough to improve the community's health. I can not just give anti-hypertensive drugs to a person, I must ensure that the diet of the whole family is modified, the physical activities are changed and the wider community advocates for changes in government policy, regulate sugar and salt content in foods, set up parks for exercises, put bike lanes in city streets among others. The entire health system must be involved and all other sectors must participate. I am sharing a blog-post from theomed.blogspot.com on the 3 reasons doctors who believe in community-oriented primary care do not join medical missions.

 

It is becoming difficult for organizers to get doctors to join them in their medical missions. I am not an advocate of medical missions. Before I give you the reasons why, let me clarify that what we mean of medical missions are the trend today of one-time events of medicals consults and surgeries with giving of medicines to patients as a tool for achieving something else. Med missions are sometimes beneficial especially during emergencies but other than that, it is an ineffective practice.


Here are three reasons why:

1. Medical missions do not address the health problem.

The medical management does not address the cause of the problem. A patient may come in with Tuberculosis due to the poor sanitation of the area, or poor nutrition, or poor hygiene habits. The current trend in medical management today is holistic approach wherein the doctor not only intervenes at the medical condition of the patient but also considers the other factors surrounding the patient. These factors include the mental, social and spiritual factors. Medical management also includes patient education on how the patient can improve her living condition, environment, lifestyle and other things more than just taking the prescribed medicines. This may not be possible as time is not a luxury during med missions. Also, some cases like TB needs further patient care which leads us to the second reason.

When Jesus healed the lepers, he restored their relationship with society. Remember, patient care is more than just treating the disease.


2. Medical missions do not provide continuing patient care.

Proper medical care is continuous and personalized. When medical missions are one time event, it does not allow for patient to follow-up with their health care provider for continuing care. Imagine the popular summer medical mission providing free circumcision to young boys. If complications happen to the wound, how will the boy get follow-up care from the healthcare giver? Even if complications do not happen, the healthcare worker are ethically bound to continue care to the patient until they are well. This will not happen in one-time medical missions. Because of time constraints, personalized care are seldom given to patients.

When Jesus touched the sick, he touched their lives and they became his friends. Remember, the doctor-patient relationship is a contract of trust for care not for a one time meeting.


3. The ultimate goal is not patient well-being.

While medical missions looks into the health condition of the patients, the intent of the mission is not always the person's health. It is an open secret that politicians sponsor medical missions with the real intent of campaigning for people support. Churches sponsor medical missions as an evangelistic tool to persuade people to become Christians. Organizations sponsor medical missions as an outreach activity to gain prestige and recognition. There are other reasons individuals and groups sponsor medical mission but few are intent in addressing the health needs of the people. If the intent is to help people achieve good health, then they know that a one-time medical mission is not enough.

When Jesus came to heal the sick, his purpose was to heal the sick. Remember, health is an end not a means. Lest I be misunderstood, when I say health, I mean the life promised by Jesus in John 10:10.

It is unethical for doctors to violate the principles of medicine. So, like most of my colleagues, I may decline invites in your one-time big time medical missions.

There maybe some benefits to the med missions but we can do better. I can name 5 health ministries churches can do. It is high time we level-up what we can do to improve the health of the community.