pillars of progress.

(The piece below was written in support of Iloilo City Mayor Jed Patrick Mabilog's nomination for World Mayor 2014 - an annual award given to outstanding mayors all over the world. He is the only Philippine mayor to be included in this year's shortlist. Read more about the award at http://www.worldmayor.com/)

I first met Mayor Jed Patrick Mabilog back in 2004 when I was selected as one of the Ten Outstanding Student Leaders of Iloilo City (TOSLIC), an event spearheaded by his HALIGI Foundation. For the non-Ilonggo speaker, “haligi” means support or pillar, and my initial impressions of him were just that: A big man with an even bigger heart, a “haligi” in every sense of the word.

In its website, The World Mayor Award seeks to recognize “a mayor who has made outstanding contributions to his/her community and has developed a vision for urban living and working that is relevant to towns and cities across the world.” For Mayor Jed, the contributions are surely many, but the vision has always been the same: Elevate Iloilo City to premier status by 2015, and snatch back its coveted title as the historical Queen City of the South.

And why not? History has always been the city’s claim to fame. Thanks to the efforts of the Iloilo City Cultural Heritage Conservation Council, restored Art Deco buildings now bask in resplendent glory along downtown Calle Real, the country’s newest heritage zone as declared by the National Historical Commission of the Philippines. Elsewhere, it’s a more striking tryst of the old and new: With business permits streamlined, government efficiency bolstered, and corruption kept in check, the city’s bullish climate became the prime battleground for the movers and the shakers of Philippine economy: Industrial parks took shape, shiny edifices rose one after another, and gung-ho investors arrived in droves. Roads and bridges enjoyed a facelift, and crime rate remained low. As a testament to these achievements, the city gained prominence in the Red Orchid Awards, the International Livable Communities Awards, and the National Competitiveness Council’s Most Competitive Cities, and bagged the honor as one of the official venues for the 2015 Asia Pacific Economic Cooperation (APEC) Ministerial Meetings.

Amid all these, environmental sustainability has not taken a back step. An avid cyclist, Mayor Jed championed the creation of crisp bike lanes along the swanky avenue slicing through the city’s new, burgeoning Central Business District. To alleviate the city’s perennial flooding problem (and avoid the cataclysmic scale of destruction spawned by Typhoon Frank in 2008), floodways were constructed in the suburbs, and the streets kept litter-free. But the administration’s crowning glory in the environmental arena would have to be the remarkable transformation of the Iloilo River – a dying waterway given a second lease on life, paragon host of the first ever Philippine International River Summit in 2012 and a finalist in the 2013 Theiss International Riverprize Awards.

Throughout the pursuit of progress, Mayor Jed has not forgotten the greatest catalysts of a city’s success: its people. In keeping with Iloilo City’s reputation as an academic center, education continued to be a top priority especially with the establishment of the Iloilo City Community College. Moreover, the government’s trademark womb-to-tomb program provides socialized services including maternal care, child immunizations, mass weddings, livelihood trainings, low-cost housing for informal settlers (especially those along the riverbanks), and even free coffin and embalming services. 

Early on, Mayor Jed realized the importance of partnerships. He has harnessed the tremendous power of public-private partnerships (PPPs) in many of the government’s key projects, and has forged a crucial alliance with Iloilo City Representative and former Mayor Jerry P. Trenas (whom I had the pleasure of working alongside during Rotary Club’s Boys and Girls Week in 2002) and incumbent Senate President Franklin Drilon – the dynamic triumvirate orchestrating Iloilo City’s metamorphosis.

“I love it here. It’s very progressive,” quipped one of my medical colleagues during a trip to the city earlier this year. We were taking a leisurely nighttime stroll along the lush River Esplanade, a tourist attraction in itself. In front of us, a group of youngsters scrambled for a mandatory photo-op before a huge sign that read, “I Am Iloilo.” Such words, I believe, must have grown to become a slogan of shared sentiments, a symbol for a city on the cutting edge of change. Under Mayor Jed’s leadership, that change had indeed spiraled into an unstoppable wave breaking barriers in all directions. He became Iloilo City’s infallible “haligi”, the proverbial pillar behind the city’s sterling story of success.

the rules of romance.

Last weekend, I hopped home to attend a joyous reunion of sorts: Two high school friends got married, and my dear cousin got engaged to an upperclassman. There’s the usual banter, of course, the all-too-familiar buzz of how their love stories unfolded: how girl met boy, or vice versa, the courtship, the proposal, preparations for the big day. The Filipino-Chinese community in Iloilo is quite small, so to speak, and in a city where everybody knows practically everybody else, one would be hard-pressed to find a huge surprise (True enough, there were no real surprises – both couples had been going at it for several years already.) The only surprise arrived way before the wedding ceremony began, in the middle of a somewhat sweltering June afternoon, with someone sidling up to me on the pew and blurting out, quite matter-of-factly: “So, when’s yours?”

Stuck in the roaring years of the turbulent twenties, it’s not as if this were the first time I found myself facing the music of the magic question, one best handed out to old, graying maids and fat, balding bachelors. As one of my erstwhile Chinese teachers remarked, “When people reach the right age, what do they do? They get married!”

Ah, if only it were that easy.

Growing up, I never considered myself really ripe enough for the romance arena, at least one to be taken seriously. My childhood and teenage years were chock-full doing academics and career stuff at school, while hobbies and family took priority at home. It didn’t help that I grew up in a society of 100 million inhabitants, propelled at a furious pace by the highest birth rate in Southeast Asia, and marred by daily news of gruesome abortions, unwanted teenage pregnancies, and broken families (Add a staunchly anti-Rh bill church and years of rotating in congested obstetric labor rooms.) It didn’t occur as a surprise therefore, that romance has always been out of the question. A personality test I took years back required me to rank the following in terms of priority: family, career, health, personal development, and romance – to which I immediately ranked romance at the very bottom, with a smug expression on my face.

Through all seven years of medical school – plus another three for residency training, I have seen how it takes an especially gargantuan degree of patience, dedication and selflessness to establish a solid relationship and make it work, or to keep an existing one going strong. For the less fortunate ones like me who had to contend with the phenomenon of single blessedness in the meantime, it's a fact of life we've grown to accept – the numerous February 14 solo dates where you pitifully got your own cake and ate it, the parties where you had no one else but your best friend or block mate to drag to, the myriad high school reunions where everyone else had husbands and babies and you still had your boring exams and textbooks. In the latter case, typical conversations included snippets of "So, have you found her yet?" to be followed after by my subtle attempt to digress. Only time will tell, I always retorted.

But time is also ticking, and my medical colleagues know it best.

I once had a conversation with a medical school classmate who’s right smack in her thirties. When I asked her about residency plans after graduation, she became pensive and shook her head. “Oh dear, I don’t think I can do residency anymore. My ovaries’ days are numbered.” I nodded slowly, smothered with a lot of understanding. Another classmate, currently in her last year of residency, bemoaned the fact that her own mother threatened her with so much as a trip to the local matchmaker should she fail to, ahem, comply with due requirements in the romance department. The urgency seemed appalling. As one family friend who got married in the nick of time narrated: “Getting married has its own rules: When you’re young, it’s all about the heart. When you’re old, it’s all about the head.” (In other words, kailangan mautak na.) When one beholds the fact that she came from a family of three consecutive old maids, such words are bound to be perfectly understandable.

Having grown up in a typical Filipino-Chinese family, you eventually get the gist of everyone else’s expectations: take a wife, bear a child (preferably a boy), and carry the family name for generations hence. In this regard, Charles Tan has an interesting and very informative take on the Filipino-Chinese wedding custom (http://charles-tan.blogspot.com/2008/06/essay-filipino-chinese-marriage.html) But just as the tides wax and wane and cutting-edge trends evolve, the once elaborate rules and traditions governing Filipino-Chinese marriages have changed as well. No, we don’t do arranged marriages anymore, sacred tea ceremonies are not an absolute necessity, and last I heard, getting kicked out of the family inheritance for failing to marry a “purebred” Chinese is about as passé as the ancient ritual of foot-binding.

So, in this crazy, postmodern 21^st century era, what exactly are the rules of romance?

I can best sum it up in perhaps three words: Follow your heart.

May you all have a lifetime of love and romance!

psf 9 update.

At long last, the Philippine Speculative Fiction 9 anthology - which includes my short story "Mater Dolorosa" - has revealed its table of contents. From the blog of editor Andrew Drilon (http://andrewdrilon.livejournal.com/93889.html):

Charles and I are very proud to announce the Table of Contents for Philippine Speculative Fiction 9. We have a wonderful range of stories for this volume, from the absurd to the ominous, profane to pious, fabulous to phantasmagoric. They are:

Blood of Iron by Christian Renz Torres
Panopticon by Victor Ocampo
A Cha-cha with Insanity by Vida Cruz
Only Dogs Piss Here by Michael Aaron Gomez
Last Race by Jenny Ortuoste
Oscar's Marvelous Transformation by Kat Del Rosario
Stations of the Apostate by Alexander M. Osias
Sikat by William Robert Yasi
Deliver Us by Eliza Victoria
Miracles under a Concrete Sky by Franz Johann Dela Merced
The Unmaking of the Cuadro Amoroso by Kate Osias
The Woodsman by Cedric Tan
And These were the Names of the Vanished by Rochita Loenen-Ruiz
Anthropomorpha by Crystal Koo
Sofia by Marianne Villanueva
Transcripts from the Investigation on the Life and Death of Alastor de Roja by Vincent Michael Simbulan
TG2416 from Mars by Nikki Alfar
Mater Dolorosa by Marc Gregory Yu
Scissor Tongue by Elyss Punsalan
Cogito by AJ Elicaño

Definitely looking forward to the book launch and to meeting the other authors as well!

bright lights, bittersweet glory.

There are battles, and there are battles.

There are Olympic Games, and there are PCP Quiz Competitions.

Thank you to everyone who came, watched, and cheered their hearts out for the PGH team.

To Deonne, Jay, and Julie – one could not ask for better teammates to fight the battle with.

To our coach Dr Mark Sandoval – thank you for your time, effort, and dedication in helping us reach peak fighting form and play the game to a triumphant finish.

To our resident colleagues in the Department, our Chair Dr Rody Sy, and our respective families – thank you for your love and support.

Most of all, to the Almighty Himself who makes all things possible – this is for You.

graphic tales (part IV)

My short story "Storms" got published in Graphic today. Of all the stories I've written, I considered this the most relevant as it deals with the struggles of an ordinary Filipino family bracing itself for the imminent attack of yet another perennial nationwide calamity, in the process forcing each member to relive the ghosts of storms past. The story's publication comes just a few months after Typhoon Yolanda brought the entire nation down on its knees, with endless communities still reeling from the impact of the disaster. But similar to the Filipinos' resilience, the story is also testament to the fact that sometimes, however ruthless the storms that come and go, the strength of the human spirit still prevails.

Read below an excerpt from "Storms":

When Lola first got wind of the tragedy, she had stood petrified, her famished heart bursting with a sorrow so great it seemed to engulf her entirely. Over and over she repeated to herself that it had only been a simple journey: He had merely boarded a ship and sailed out to the Visayan Islands where a crucial business meeting awaited him. She had kissed him off at the port with the toddler in her arms and he had waved a cheeky goodbye, promising a swift return after five days, and he would bring her postcards of Magellan’s Cross, the Chocolate Hills, a cute, cuddly tarsier. She had watched with a doleful look as the ship drifted along – as far as her hazy memory allowed her – smooth, azure waters that bore no inkling whatsoever of the terrible disaster that is to befall it, brimming instead with crystalline ripples of infinite potential. She remembered that scene as though it had been imprinted in her paltry mind: Her anxious face and his mirthful smile, the last rays of the afternoon sun atop the foamy bed of crashing waves.

torrents and regrets.

After the torrents, they came – in torrents.

Storms and typhoons have become a rather inconvenient norm for us Filipinos. And every year, we brace ourselves for the storm of all storms: Last time, it was Milenyo whipping up a tumult; the other time, it was Ondoy, swamping up everything in its path; and for the past two years (this year included), we buckled under the torrential rains of the not-so-puny habagat.

But storm or not, all of them carried a similar denominator in their aftermath – swarms and swarms of leptospirosis patients.

They came – burning fevers, yellow eyes, failing kidneys, and all – to the gates of the hospital, oftentimes armed with nothing but stories in their heads and telltale cuts on their feet. And like the old times, we doctors were there to promptly answer the call of duty – but only just.

Only just?

I regret nothing in the way we handle our leptospirosis patients in PGH. Having been stationed in the ER the past month and rotating with Infectious Diseases this month, I only have praises for the selfless medical teams who work overtime – from the fellows and staff manning the dialysis unit to the pharmacists dispensing boxes of antibiotics, to the administrators formulating workable guidelines all the way to the unnamed benefactors of the PGH Leptospirosis Fund.

What I – and most of us – wholeheartedly regret is the fact that every year, we hear the same old stories. We see the same old faces, and face the same old frustrations. The root of these endless leptospirosis epidemics obviously stretches far beyond the confines of murky, rat-infested waters and life-altering storms. It seeps its way into the shameless pork barrels of lawmakers who’d rather guzzle up taxpayers’ cash abroad rather than invest on preventive health programs. It finds its way into the shanties of the abject poor, devoid of any access to basic education or information, oblivious to the fact that potential deaths from complications such as kidney failure or pulmonary hemorrhage can be averted with timely doses of an inexpensive pill. It knocks on the doors of Mother Nature herself, collateral victim of haphazard and oftentimes senseless urbanization.

Sadly, our role as doctors can only do so much. We see a case, work our asses off, heave a sigh of relief upon the patient’s discharge, or mope in silence after signing yet another death certificate. We know that each leptospirosis patient will always be part of a far bigger problem – one that will take a huge amount of national resolve, environmental advocacy, and political will to address.

Then, and until then, we shall always remain a nation of torrents – and regrets.

closures.

“Thank you, doctor, for giving us closure.”

That was what the patient’s sister said, in between shedding tears, as she gathered with the rest of her family inside the humid, overcrowded emergency room of the country’s biggest tertiary hospital. A frantic call in the middle of the night relaying news of her brother’s moribund state had forced her on the first flight back to the Philippines, and her weary face was at once a tapestry of mixed emotions: denial, grief, desperation, guilt, and finally, acceptance. Earlier that morning, I had engaged the family in an exhaustive talk that entailed a detailed explanation of the patient’s condition (best summarized as terminal cancer, comatose, poor prognosis), available options (to resuscitate or not, to continue aggressive medical management or not), and continuous reassurance (whatever your decision is, we will still provide the best possible care.) In the end, everyone settled for a quiet, non-intrusive approach that allowed the patient a peaceful death; no hefty measures.

Medicine in the new millennium has always focused on the quest for innovation: new drugs, new tests, new surgeries. These advancements in health care enabled doctors to work at a faster pace and deliver better outcomes, but somehow at the expense of less patient interaction. In an age where speed is king and efficiency is the rule, barely enough time is spent explaining the nature of the disease, offering diagnostic and therapeutic choices, providing ample reassurance – things which are incidentally just as important as their biomedical counterparts.

I, too, used to believe that the magic formula of “subjective-objective-assessment-plan” – so lovingly imparted to us in medical school – was the celebrated panacea to all my patients’ complaints. There’s the stirring fire of youth and idealism, plus the messianic way Filipinos often regard their doctors (As one patient entreated with supplication, “Kayo na po ang bahala sa lahat.”) During my residency training in Internal Medicine, I was stationed inside a government institution bursting at the seams with patients from all corners of the country. A lot of these were intriguing, complicated cases, and I was determined to push for gallant interventions no matter what. Many times, however, after an overwhelming rollercoaster ride that cost my patients an arm and a leg, I ended up tired and frustrated – a good number died despite my best efforts, and I further faced relatives who were just as confused, angry, and depleted to the hilt of financial and material resources. What happens when even the most exacting principles of science cannot give us solutions? What happens when even our noblest intentions fail to prolong life?

And then, my patients slowly taught me the value of the talk.

By talking, I mean a frank, honest, no-frills talk: A talk that raises no undue expectations; only real ones. A talk that might sting with the intensity of freezing water, but which will lead to a much-needed, much-yearned closure.

The realm of medicine is a rapidly evolving one, with mysteries lurking at every corner, answers waiting to be unearthed in the depths. Dr. William Osler, the pioneer of modern medical teaching, often preached that the role of a doctor is “to cure sometimes, to relieve often, and to comfort always.” Cure is perhaps the most tangible concept, manifest in the myriad breakthroughs and discoveries of medical research. Relief, too, comes in the form of alleviating pain and affording a more acceptable health-related quality of life. But comfort is rooted deep in empathy, the embodiment of an innate desire to help a genuinely suffering person. Despite the inherent shortcomings of our relatively resource-poor health care system, I realized that proper and meaningful communication seemed to raise the bar each time I sat down with a patient and/or his/her relatives, making the experience much more personal and profound. I eventually learned to throw away the proverbial coat of invincibility and omniscience and lay down all my cards: As physicians, we may not always have the remedy to every ailment – but we are there to reach out a hand, to walk every step of the way.

It is a task both daunting and difficult, especially when you find yourself confronted with a visibly distraught husband, a daughter transformed into a huge bawling mess, or several passionately argumentative family members. And perhaps quite understandably so. For how could a star athlete suddenly succumb to a heart attack? (“Hindi ito posible,” his bereaved girlfriend pronounced.) How could someone walking and laughing a few minutes ago abruptly collapse from a massive stroke? (“Paano nagkaganyan?” The horrified brother countered.) Discussing advanced directives, in particular, is a delicate matter. Many family members are unwilling to make decisions for an incapacitated patient even though they possess the legal right to do so. “Ayoko masisi ng mga kapatid ko,” reasoned the eldest son. “Hintayin na lang natin ang aking manugang,” begged the elderly wife. It takes a lot of patience and perceptive acumen to guide the surviving family members through the crucial process, but it is a necessary means for closure – and the result can prove both enlightening and empowering.

More than anything, helping people achieve closure made me marvel at the unique strength of character, the tightknit closeness of kith and kin, and the earthshaking, resounding faith in God that proudly characterizes the Filipino spirit. I met families who chose to have their loved ones spared from traumatic intubations or fractured ribs from excessive chest compressions during resuscitation. I met families who chose to forego gargantuan procedures bordering on the futile, with a firm decision not to pursue the farfetched moon and stars. I met families who nodded with understanding, who managed to smile despite the grim reality, who offered gestures of gratitude for words well-spoken and time well-spent. I met families who saw the value of dying peacefully.

Looking back at that pivotal moment in the emergency room, I may have failed to keep the patient physically alive, incurable as his disease is. But it warms the heart a little to know that I was able to share what little time I had with the family he left behind – now coming full circle, now cloaked in mourning, now bonded in closure. I am reminded of Dr. Osler’s fabled words to “cure sometimes, relieve often, comfort always,” and just like that, I learned to find it in myself as well – a certain kind of closure no amount of medical training can ever give.