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5 TB Movie: "Flying Kiss" 9 Malaria Elimination Soon 5 10 World Health Day 2014: Vector-Borne Diseases 11 Pinoy Youth Today 15 5 R's to Stop Abortion 16 Condoms for Quezon City 17 I'm a Lifeline 19 Top 10 Myths on Organ Donation 21 Lessons from Yolanda 23 Tindog Visayas 25 EVRMC Rising 30 POC Modernization 32 Marijuana and Medical Necessity 17 23 35 DDB on Medical Marijuana 38 Guilt is No Better than Greed 41 Let's Do the 52-100 42 More Hospitals to Care for the Heart 43 Hey, Sugar! 44 Fouride Toothpastes 45 Nutritionist-Dietitian of the Year 46 Prophecy Fulfilled?!? 47 Leprosy Alert and Response Network System 25 48 Pabakuna Po... jokes n'yo 48 laughter HEALS 20 stress RELIEF 29 XX KALAbeat 31 SAbeat 50 DEPARTMENT OF HEALTH - Health Promotion and Communication Service (formerly National Center for Health Promotion) 2F Bldg. 18, San Lazaro Compound, Sta. Cruz, Manila 1003, Philippines I Tel. No. (63-2) 743-8438 HEALTHbeat Website: www.healthbeat.com I Facebook: www.facebook.com/DOH.HEALTHbeat.ph I Email: [email protected] Health Promotion Let it be clear that the National Center for Health Promotion is not kissing everyone goodbye as it continues its appeal to the Department of Budget and Management to reconsider turning the office into a "bureau" instead of a "service" in the Rationalization Plan of the Department of Health. However, while waiting for that crucial decision, we will follow the recent DOH order and use our new name just like any other office in the "rationalized" structure. HEALTHbeat would want to insist though to make it a more grammatically correct and consistent nomenclature and call our office the Health Promotion and Communication Service (HPCS), without the letter "s" in the word "Communications" as what is being circulated in official documents.

So what's in a name? Ah, so many implications! If we will not become a "bureau," then we would lose the higher plantilla positions, and rumor has it that we might not also retain the health programs that we have been managing for quite some time. We may be relegated again into a "servicer of services," a support to all programs and a master of none. In an era when Health Promotion has gained a foothold globally as an area of expertise in the prevention of diseases, we are downgraded to a stature that we were three decades ago as a public information Editorial Board and health education office. Ivanhoe C. Escartin, MD Rosemarie G. Aguirre Whoever thought of our new structure and functions has lost touch with reality and global trends in health care delivery. Maybe he/she or they would be better off retired to see the world and Chief Editors Anthony R. Roda broaden their knowledge on, and more importantly not meddle with, health leadership and May Elenor R. de Guzman governance. But as we have learned in nursery, sticks and stones will hurt their bones and words Managing Editor Donato Dennis B. Magat will never harm them. The most badly affected are the people in health promotion and their process, passion and hope for better health of Filipinos. Staff Writers Elizabeth G. Mascareňas Glen S. Ramos

Health Promotion is the process of enabling people to increase control over and improve their Photographer Paquito P. Repelente health. To reach complete physical, mental and social well-being, an individual or group must be able to realize aspirations, to satisfy needs and to change or cope with the environment. Health Cover Design Diosdado G. Angeles, Jr. Promotion is the first step to disease prevention. It must start with people who are basically Graphics Design Rhoderic N. Domingo healthy by enhancing behaviors that promote well-being and strengthening community Frederick C. Pereňa measures and individual lifestyles for the maintenance of good health. And it is about time to put a substantial portion of the limited government resources to strategies and programs targeting Contributors (Words) Jonas del Rosario, MD the majority of the population who are healthy but very much at risk of getting diseases. Grace Arceo Malubag Willie T. Ong, MD Sadly, expanding our office to become a "bureau" is not within our control. It lies in the hands ASec Paulyn Jean Rosell-Ubial, MD of the few powers that be to hear or ignore our plea. In the meantime, HPCS (formerly National Tato M. Usman, MD Center for Health Promotion) insists that you have time to relax and see our latest movie - "Flying (Photos) Joerem P. Ceria Kiss," and it is all about TB. Rizalito L. Santiago, Jr.

- The Chief Editors Circulation DOH-HPCS Resource Center

FOR EDUCATIONAL PURPOSES ONLY. NOT FOR SALE. Opinions expressed in this publication do not necessarily represent those of the DOH. The mention of specific companies or of certain manufacturer’s products does not imply that they are endorsed or recommended by the DOH in preference to others of similar nature. Articles may be reproduced in full or in part without prior permission, provided credit is given to the DOH for original pieces. A copy of the reprinted or adapted version will be appreciated. Articles, artworks, photographs, caricatures, letters and other contributions are most welcome. Materials will be edited for clarity and space. Unsolicited manuscripts will not be returned. Contributors must indicate their names and addresses.

4 HEALTHbeat I March - April 2014 HEALTH movie

From left to right: Carl Guevara, Andrea Tatad, Wyn Marquez and Fabio Ide TB Movie: "Flying Kiss" by ANTHONY R. RODA, MaHeSoS HEALTHbeat Staff

"Flying Kiss" and laughter, and a disease that kills 75 into Multi-Drug Resistant-TB (MDR-TB). As Filipinos daily. It tells the story of Mich if this is not worse enough, she also loses Living in the fast lane and wanting (Andrea Tatad), a lower-middle class young her fiancé to her best friend, Michelle (Wyn to accomplish many things at greater speed woman who is about to achieve all her Marquez). not only to make both ends meet but to dreams, including marrying her well-to-do Mich finds herself in a halfway have enough money to make the family handsome Prince Charming, Kevin (Fabio house to receive new treatment and will live comfortably is a life that many Filipinos Ide), until she is diagnosed with active TB be monitored if she takes her medication make at this day and age. and everything is put to a halt. She agrees religiously. Here, she experiences difficulties Life seems to be all about finding to take her medication for six months, but in coping with her disease, but the health shortcuts to success, is it not? But what if because she was too preoccupied with workers and her fellow patients are always you have acquired tuberculosis (TB), could a the romantic circumstances in her life, she there to help her in her ordeal. She meets person find a way to get well soon? misses some days and totally stops taking Allen (Ralph dela Paz) a young man who was “Flying Kiss” is an advocacy the treatment when her condition feels a disowned by his family after getting TB as a movie about family and friendship, love little better. Because of this, her illness turns complication of HIV; Mama Bon (Ate Gay),

March - April 2014 I HEALTHbeat 5 a gay who tries very hard to make himself Advocacy Via Movie company that specializes in conceptualizing, and other patients happy; and Prince (Carl producing, managing and implementing Guevarra), "in a relationship” with Mama "Flying Kiss" is a joint venture advocacy projects. Bon and frequently visits the health facility of the National TB Program (NTP) of the Dr Rosalind G. Vianzon of the to look after him. DOH Disease Prevention and Control DOH-NTP said that this first TB movie gives Mich gets cured and lives a normal Bureau and the Health Promotion and a different ambiance on TB as a disease and life. She uses her leadership quality and her Communication Service (formerly National hopes on improving the health-seeking creativity to start a successful livelihood Center for Health Promotion) together with behavior of Filipinos, aside from the business. She also becomes romantically the Philippine Business for Social Progress entertainment value that was built-in. involved with Prince after finding out that (PBSP) through its The Global Fund (To Fight The movie had a gala premiere on Mama Bon is his brother and not his lover as AIDS, Tuberculosis and Malaria) Project. February 24, 2014 at The Block Cinema of Mich earlier suspected. PBSP funded the production while the DOH SM City North Edsa. It was shown in select “Flying Kiss” also stars Maria Isabel provided technical inputs and guidance cinemas on March 19 - 25, 2014, in time for Lopez, Macy B, Cheska Carillo, Gio Medina, on the movie screenplay and the advocacy the World TB Day on March 24. Avin del Rosario, Raymond Rinoza and campaign. The movie is produced by the Part of the proceeds will go to Regine Mendieta. It is produced, written Sinehan Advocacy Media Projects, Inc. anti-TB advocates called the "TB Task Forces." and directed by Crisaldo V. Pablo. (SAMPI), an independent media advocacy They are groups of private citizens that roam

6 HEALTHbeat I March - April 2014 the streets of Metro Manila, and brave even The movie does not end with the City, Mandaluyong City, Makati City, Las the most dangerous and least accessible regular cinema screenings because its real Piñas City, Pasay City. More companies are areas of the metropolis to talk and educate intention is to be screened in communities, also signifying their intention to become the people about tuberculosis. They also look campuses and workplaces at a minimum partners in this advocacy. for possible TB patients and convince them cost agreed upon with SAMPI. Interested For group screenings, please email to avail of the needed interventions to cure public or private institutions may sponsor [email protected]. their disease. More importantly, they take a screening for a certain audience of their care of TB patients who stay at home and choice. During these screenings, the holding Fight Against TB help ensure that these patients follow the of a seminar or discussion on TB issues and needed daily medications for at least six concerns and even exhibits may be held. TB is still a major health problem months so that they can fully recover. Already joining the advocacy via in the Philippines. It is the sixth leading Most of these Task Forces do not movie are Hewlett-Packard Philippines, cause of death and illness. It is estimated have the necessary resources to continue Yamaha Motors Philippines, Western Digital, that 260,000 Filipinos have active TB and their fight against TB. SAMPI, through Monteverde Sewing Machines (the official the country is among the 22 “high-burden” the movie, would help them raise funds Philippine distributor of Singer Sewing countries for TB epidemic. Along with China, to sustain their activities as well as to Machines), Asian College, Yadu Bags, Cambodia, and Vietnam, it accounted for compensate the efforts of their members. Nyogi, and the TB Task Forces of Quezon 93 per cent of TB cases in Western Pacific

March - April 2014 I HEALTHbeat 7 Region. later. In healthy individuals, infection often private clinics, some hospitals, prison clinics, But despite the high TB incidence, causes no symptoms, since the person’s and other facilities. Under DOTS, a relative significant progress has been made in immune system acts to wall off the bacteria. or a health worker directly observes the increasing case detection and treatment in The symptoms of active TB of the lungs are patient taking anti-TB medicines daily. The the country. The World Health Organization coughing, sometimes with sputum or blood, Philippines’ DOTS treatment success is placed (WHO) Global Tuberculosis Report 2012 chest pains, weakness, weight loss, fever and at 90 per cent, higher than the WHO target of showed the number of Filipinos afflicted night sweats. TB can also affect other organs 85 per cent. with TB decreased by 52 percent and TB of the body, such as the kidneys, spine or A major challenge in treating the casualties by 49 percent. TB prevalence is brain. Symptoms depend on the organ disease is MDR-TB. This occurs because TB high among the high risk groups such as affected. It is important that TB should be patients do not adhere to the drug regimen, the elderly, urban poor, smokers and those checked and treated as early as possible. meaning they do not take their medicines with compromised immune systems such Filipinos need not suffer from every day for the usual six months period. as people living with HIV, malnutrition and TB nor hide from the stigma that has Because of this, the TB bacteria develop a diabetes. It is estimated that 10,600 patients been attached to the disease for decades resistance to isoniazid and rifampicin, the have MDR-TB in 2011. This situation leads that prevent them from receiving proper two most powerful TB drugs. MDR-TB is more to substantial socio-economic losses to the treatment. The DOH-NTP aims to detect 85% difficult and expensive to treat. Another country. of active TB cases and cure at least 90% of challenge is the estimated 65,000 TB cases TB is an infectious bacterial disease these cases. It has adopted the Directly that remain undetected and untreated. that most commonly affects the lungs. It Observed Treatment Short-course (DOTS) These are called the “missing TB cases,” and is transmitted from person-to-person via program, recommended by the WHO. each of them can spread the disease to 10 droplets from the throat and lungs of people Persons with TB can access free other Filipinos each year. with the active TB. Signs and symptoms can diagnostic test using sputum microscopy and Thus, fight against TB and the occur in the first few weeks after infection anti-TB drugs from different DOTS facilities dissemination of right information on its with the bacteria, or it can occur a few years such as the rural health units, health centers, prevention, treatment and control continue.

Health Assitant Secretary Enrique "Eric" A. Tayag doing an Ellen Degeneres at the Oscar's+=+ by taking a selfie photo during the FLYING KISS press conference. From left to right: Crisaldo V. Pablo, director of the movie; Reno Carter Nalda, PBSP-Global Fund program manager; ASec Tayag; Carl Guevarra, lead actor. (Photo by Rizalito L. Santiago, Jr.)

8 HEALTHbeat I March - April 2014 malaria ELIMINATION Malaria Elimination Soon "The Philippines is on course of eliminating malaria by 2020," reported the Department of Health during the 6th Meeting of the Asia Pacific Malaria Elimination Network (APMEN) in Makati City on March 11-13, 2014. APMEN is a network of 14 Asia- Pacific countries working towards the elimination of malaria as a public health threat by sharing country successes and challenges in malaria elimination and dvelopment of plans that focus on regional The 6th Meeting of the Asia Pacific Malaria Elimination Network (APMEN) Press Conference: From left cooperation, advocacy, knowledge exchange to right: Prof Gao Qi (APMEN Board Chair), Dr Thomas Teuscher (Roll Back Malaria Partnership), Sir and capacity-building. Richard Feachem and Health Assistant Secretary Enrique Tayag (APMEN Co-Chair); Edgar Chua (Shell Health Secretary Enrique T. Ona, Companies in the Philippines); Dr Mark Jacobs (World Health Organization); and Dr Susann Roth (Asian in his speech during the welcome dinner Development Bank). (Photo by Paking Replente) for the delegates, said that this past decade showed significant progress in the reduction commitment from the local government and advocacy activities. The establishment of malaria cases and deaths in the country units has also increased, enabling the local of alliances between the government due to improved diagnostic modalities, health systems to become more responsive and the private sector, corporations, the use of artemisinin-based combination to the task and challenge of malaria business communities and religious and therapies for malaria treatment, and elimination and the local implementation of civic organizations is playing a significant improvement in vector control interventions. interventions. role in achieving malaria elimination and He also emphasized the concerted efforts But as domestic resources improving the health status of communities. of the national and local governments, the increased, Ona said that these are not Malaria cases declined since the private sector, the scientific community and enough to fully achieve malaria elimination. mid-2000s, and have resulted in an 83% international donors in their technical and The need for external funding persists, reduction from 2005 to 2013, while there financial support to the implementation of especially in the assurance of universal and was a 92% reduction in the number of interventions. equitable coverage of malaria interventions deaths within the same period. The number Ona said that malaria and the strengthening of an elimination- of cases went down from 46,342 cases in belongs to a group of diseases with an oriented surveillance systems. 2005 to 7,720 in 2013. Deaths were 150 in elimination initiative – along with rabies, Aware of the tough competition 2005 to 12 to last year. The Philippines has schistosomiasis, leprosy and filariasis – and for external aid, technical experts in the achieved the Millennium Development Goal forms part of the thrust of the government Philippines National Malaria Program are target for 2015 as early as 2008. to achieve better health outcomes for the continuously looking for ways to make Of the 53 known provinces Filipinos, through elimination of illnesses interventions more cost-effective and endemic for the disease, 27 have already and deaths from diseases which are entirely service delivery, more efficient. In the midst been declared malaria-free. These are Cavite, preventable. He added that for malaria, the of lowering incidence, there remains the risk Batangas, Marinduque, Catanduanes, government budget has increased from that commitment to malaria elimination Albay, Masbate, Sorsogon, Camarines Sur, US$67,000 in 2002 to US$7.2 million in would wane. The program tries to address Iloilo, Aklan, Capiz, Guimaras, Bohol, Cebu, 2014, a 99% increase in 13 years. Political this through persistent social mobilization Siquijor, Western Samar, Eastern Samar,

March - April 2014 I HEALTHbeat 9 Northern Samar, Northern Leyte, Southern hard-to-reach areas such as in the hills, under-five are also considered to be at high Leyte, Biliran, Camiguin, Surigao Del Norte, mountains and coastal areas. Disease risk, including pregnant women. Benguet, Romblon, Batanes and Dinagat transmission is perennial and generally Malaria elimination entails Islands. higher during the rainy season. High- reducing to zero the incidence of locally Malaria is a disease caused by risk groups consist of upland subsistence acquired malaria infection in a specific parasite called plasmodium. It is transmitted farmers, forest workers, indigenous people geographic area as a result of deliberate by the bite of a mosquito vector, anopheles. and settlers in frontier areas, including efforts, with continued measures in place to The disease usually thrives in the rural and migrant agricultural workers. Children prevent re-establishment of transmission.

World Health Day 2014 highlights Vector-Borne Diseases World Health Day, celebrated on animals. Mosquitoes, for example, not April 7 every year to mark the anniversary only transmit malaria and dengue, but of the founding of the World Health also lymphatic filariasis, chikungunya, Organization (WHO) in 1948, highlights Japanese encephalitis and yellow fever. vector-borne diseases as a priority area of The campaign aims to raise public health in 2014. awareness about the threat posed by Vectors are organisms that vectors and vector-borne diseases and transmit pathogens and parasites to stimulate everyone to take action, from one infected person (or animal) particularly: to another. Vector-borne diseases are • families living in areas where illnesses caused by these pathogens and diseases are transmitted by vectors parasites in human populations. These know how to protect themselves; diseases are most commonly found in • travellers know how to protect tropical areas and places where access themselves from vectors and vector- to safe drinking-water and sanitation borne diseases when travelling to systems is problematic. countries where these pose a health The most deadly vector-borne threat; disease, malaria, caused an estimated commitments from ministries of health, • in countries where vector-borne 660,000 deaths in 2010. Most of these regional and global health initiatives – with diseases are a public health problem, were African children. However, the the support of foundations, non-government ministries of health put in place world's fastest growing vector-borne organizations, the private sector and the measures to improve the protection disease is dengue, with a 30-fold increase scientific community – have helped to lower of their populations; and in disease incidence over the last 50 years. the incidence and death rates from some • in countries where vector- Globalization of trade and travel and vector-borne diseases. borne diseases are an emerging environmental challenges such as climate World Health Day 2014, with its threat, health authorities change and urbanization are having an campaign running through the entire year, work with environmental and impact on transmission of vector-borne spotlights some of the most commonly relevant authorities locally and in diseases, and causing their appearance known vectors – mosquitoes, sandflies, neighbouring countries to improve in countries where they were previously bugs, ticks and snails – responsible for integrated surveillance of vectors unknown. transmitting a wide range of parasites and to take measures to prevent In recent years, renewed and pathogens that attack humans or their proliferation.

10 HEALTHbeat I March - April 2014 youth HEALTH

GOOGLE SEARCH NG MGA MAGULANG NGAYON. HEALTHbeat enhances this picture posted at to somehow fit this article.

2013 Young Adult Fertility and Sexuality Study 4 Pinoy Youth Today Why Study the Youth? and the fourth one – YAFS 4, commenced of the primary sources of information on in 2012, conducted in 2013, and is set to be sexual and non-sexual risk behaviors and The Young Adult Fertility and completed by July 2014. its determinants in the Philippines, at the Sexuality (YAFS) Study is a series of YAFS 4 is co-funded by the national and regional levels. YAFS covers a national surveys on the Filipino youth by Australian Government, United Nations wide range of topics that are relevant to this the University of the Philippines Population Population Fund (UNFPA), Philippine Council age group such as education trajectories, Institute (UPPI) and the Demographic for Health Research and Development labor force participation, relationships and Research and Development Foundation (PCHRD), and the Department of Health. roles in society, values and attitudes, in (DRDF). The suveys were conducted in 1982, Gathering data from Filipino addition to the risk behaviors. Findings from 1992, 2002 with results released in 2004, youth aged 15 to 24 year-olds, YAFS is one the YAFS series have been widely used in

March - April 2014 I HEALTHbeat 11 education and health and had provided the the youth is characterized by a period of noted how media consumption of young evidence base for health programs for young many critical transitions: school leaving, first adults had shifted through the years. “Young people by government and non-government job, first serious relationship, first marriage, people’s consumption of traditional forms of organizations nationwide. first pregnancy, among others. mass media, especially of newspapers, has Rapid technological change So what did the YAFS 4 says about been low and this declined further in 2013. especially in communications technology, Pinoy youth today? The following are some This however, does not necessarily mean the changing landscape of Philippine labor, of the results that were released at the that they read less. It could be that they get emergent issues in reproductive health such GT-Toyota Asian Center Auditorium in UP their news online now”. as the rising prevalence in HIV infection, Diliman on February 6, 2014. In 2013, six in 10 of young people premarital sex, teenage pregnancy and in this age range are regular internet sexually transmitted infections (STIs) among Internet and Social Media users, more than half have social network today’s youth - all provided the impetus to and email account and 78% have mobile collect new data on young people through When Mark Zuckerberg and his phones. On average, they spend 6 hours YAFS 4. friends first toyed with the idea of Facebook a week online, some logging in as much YAFS 4 contains the same basic in 2004, young people today were just as 35 hours of internet use. Females, the data gathered in previous rounds, but kids. Now, these kids comprise the 15-24 younger youth and those from economically expanded its range of topics as well as added age group and appear to be the biggest better off regions show higher social media new questions to previously existing topics. consumers of information technology consumption than males, older youth and It has a new topic on Health and Lifestyle developed by young people their age a those coming from poorer regions. (including a short depression scale). The decade ago. This pattern of internet and topic on Media has been expanded to Dr Grace Cruz, the main author of information technology use translates on include the new forms of communication the study on media use and youth lifestyle how they build relationships. One in three phenomena that were not yet well-developed in 2002 such as cell phone use, social media and cyberbullying. YAFS 4 has a total of 19,174 respondents with 51.2% males and 48.8% females. The respondents were divided into the 15-19 years old which represent 40.9% and 20-24 years old, 59.8%. The United Nations, for statistical consistency across regions, defines “youth” as those persons between the ages of 15 and 24 years. The youth is best understood as a period of transition from the dependence of childhood to adulthood’s independence. It is often considered a critical period, a time of magnificent promise and HIV/AIDS prevention and control advocacy poster intended for out-of-school youth produced by the Philippine NGO insidious risk. Demographically, Council (PNGOC) on Population, Health and Welfare, Inc.

12 HEALTHbeat I March - April 2014 healthier than average.” In addition, they also find their body weight as “normal” or “alright” while 20% said that they feel they are too thin. Data from YAFS 4 also show that 2 in 3 young Filipinos engage in physical exercises and 67% do it at least twice a week. More young men than women regularly exercise. When it comes to leisure activities, media and technology related activities dominate young people’s choices – watching television (49%), texting (30%), listening to music (22%), and surfing the internet (13%).

Drugs, Alcohol and Smoking

While there will always be young people who continue to experiment with sex, drugs and alcohol, today’s generation of young Filipinos seem to behave better compared to their counterpart a decade ago. YAFS 4 shows that the levels of current drug use, drinking alcohol and smoking among young people aged 15-24 have dropped considerably. The declining pattern is found in the practices of both young men and women, as well as in younger and older youth. The percentage of young people who are “current smokers” declined from "Search" by Dan Kalinga of Bacoor, Cavite - special award in the Graphic Health Warnings (GHW) Poster 20.9% in 2002 to 19.7% in 2013. Eleven Making Contest of the New Vois Association of the Philippines (NVAP). NVAP aims to save lives by advocating for the passage of an acceptable GHW law in the country". years ago, 41% of young Filipinos reported to be “current alcohol drinkers”. Now, only young people for instance said that they cent (68%) reported that they consume 37% of young adults are engaged in this have friends whom they only met online, carbonated drinks at least once a week. Six behavior. But the most substantial decline is while 25% have friends whom they met (6) in 10 have instant noodles and chips in found in drug use. Only 4% admitted to have through text and have not seen personally. their weekly fare while slightly more than ever used drugs in 2013, compared to almost half eat grilled street food at least once a 11% in 2002. Lifestyle and Media week. The National Capital Region (NCR) But according to Dr Cruz, “they still has the highest level of youth smokers A typical diet of a young Filipino consider themselves of good health, with (27%) while the Autonomous Region in includes instant noodles, chips, grilled street 16% even giving themselves very healthy Muslim Mindanao (ARMM) registered the food and carbonated drinks. Sixty eight per self-assessment, while 26% said they are lowest. Only 12% of young people in ARMM

March - April 2014 I HEALTHbeat 13 are smokers. premarital sex than those who are never experienced sex with another man (MSM). Dr Nimfa B. Ogena, professor of married. According to Marquez, although this Among individuals who are either formally Demography at the UPPI and the main author may suggest that marriage or cohabitation married or in a live-in arrangement, 3% said of the paper on non-sexual risk behaviors is the likely outcome of early sexual activity, they ever had an extra-marital affair. of Filipino youth said that although there such pattern remains to be analyzed from “Clearly, what we see here is not has been no analysis done yet to explain the dataset. only the increasing level of premarital sexual the pattern in risk behaviors displayed by engagement of young people, but that it the current generation of Filipino youth, Unprotected Sex has also evolved into other forms of sexual the latest findings should give adults less activities. The more worrisome though is reason to worry about the state of the youth. Despite years of information the fact that most of these activities go “Perhaps smoking, drinking and drug use campaigns on the risks of sexually unprotected,” said Marquez. have become too expensive for them, the transmitted infections and unplanned youth has found other vices, or they are just pregnancy from unprotected sex, majority Teenage Pregnancy getting more responsible,” she added. of today’s young people had their first premarital sex experience without the use of The percentage of young girls aged Premarital Sex condom or any other form of contraception 15-19 who have begun childbearing had to protect from pregnancy or sexually- more than doubled within the past decade. Thirty two per cent (32%) of transmitted disease. The YAFS survey in 2002 found young Filipinos aged 15-24 had engaged in YAFS 4 shows that 32% of young that 6.3% of girls 15-19 years old were sex before marriage, up from 23% reported Filipinos between the ages 15 to 24 have either pregnant for the first time or were a decade ago. had sex before marriage. Of these, 78% already mothers. In YAFS 4, this percentage “While the increasing pattern of reported that their first sexual encounter climbed to 13.6%; 1 in 10 girls aged 15-19 premarital sexual activity is expected, what was unprotected: 84 percent among young was already a mother while 2.6 percent we found notable in this new data is the women and 73% among young men. were pregnant with their first child when narrowing gap in the level of premarital sex The same study also found that they were interviewed in 2013. Among girls (PMS) prevalence between young men and 7.3% have engaged in casual sex while 3.5% aged 15 when interviewed in 2013, almost women,” said Prof Maria Paz Marquez, one of have had regular sex without emotional two per cent (2%) had begun childbearing. the authors of the study. attachment (FUBU or fu--ing buddies). Five This proportion increases as age increases In 2002, the percentage of young per cent (5%) of young men disclosed having such that among those who were aged 19 women with premarital sex experience when interviewed in 2013, 1 in 3 had already stood at 16 percent, almost half the level begun childbearing. found among young men (31.2%). A decade “This result does not come as a later, 36% of young men reported having surprise, especially if we link this with what engaged in premarital sex compared to 29% we found regarding sexual behavior of among young women. Regional difference young Filipinos today”, said Marquez. in premarital sex prevalence shows the NCR Results from YAFS 4 show having the highest prevalence at 41 percent increasing proportion of young Filipinos and ARMM, the lowest (7.7%). have engaged in premarital sex, and Similar to the pattern found in PAULO: Dad, ano na nga ba majority of them reported that their previous YAFS surveys, in YAFS 4 there is ang tawag sa damit first sexual experience was unprotected higher level of PMS among young people na pambuntis? from the risks of pregnancy and sexually aged 20-24 (54%) than the 15-19 age Fraternity dress ba? transmitted infections. Whether these early group (17%). In addition, young people EDWARD: Mali! Panlalake 'yun! pregnancies are the direct outcome of early who are either formally married or in live- Sorority dress dapat! and unprotected sex is a subject for further in arrangement have higher prevalence of study of the YAFS 4 data.

14 HEALTHbeat I March - April 2014 responsible PARENTHOOD Photo grabbed from the Internet

5 R's to Stop Abortion

Health Secretary Enrique T. Ona ment and upgrade of birthing facilities women in the reproductive age group, there reiterated the need to inform the public continues. This is to ensure that the health are things you should know about should you on how to stop or prevent abortion as he centers have the capacity to perform normal decide to have a baby: (a) Be aware if you are cited data from the country’s major medical spontaneous deliveries, and to refer these a high risk pregnancy. Having a first baby, centers that show abortion ranking high patients to hospitals should complications a fifth baby onward, being under 18 years among their admitted cases. arise. The referral system should be improved old, and being more than 35 years old are all “The Department of Health is to ensure timely coordination between considered high risk; (b) Get prenatal check- against abortion. This is the reason why we health facilities. The mother should be aware ups. On the average, a pregnant woman want to provide accurate information to our beforehand which health facility (e.g. lying- needs to see a doctor every two months; (c) people so that individuals can take charge of in clinic, birthing center, or hospital) she Stop smoking and drinking alcohol. their health,” the health chief said. plans to give birth in. 5. RESPONSIBLE PARENTHOOD In a recent DOH report, a high 2. READY SKILLED HEALTH – Two strategies are needed to reduce the number of abortion cases was recorded in WORKERS – One of the important factors numbers of mothers dying. First, we must the country’s medical centers such as Dr. Jose in reducing maternal mortality is to increase reduce teen pregnancies. This can be done Fabella Memorial Hospital, Tondo Medical the number of deliveries performed by skilled through health education of the teens Center, Quirino Memorial Medical Center, health workers. Doctors, midwives, and and also the parents. Parents can try to and Jose Reyes Memorial Medical Center, nurses should be trained to deliver babies. communicate with their teens about sex- East Avenue Medical Center, all located in Mothers should get adequate prenatal care, related issues. A faith- or community-based Metro Manila; Paulino J. Garcia Memorial which include the management of anemia, intervention can help in counselling teens Research and Medical Center in Cabanatuan high blood pressure and diabetes during to avoid risky behavior. Second, we should City; Cagayan Valley Medical Center; Baguio pregnancy. advocate for the three-year birth spacing General Hospital and Medical Center; and 3. READY FUNDS – Having a baby rule and reduce unplanned pregnancies. Vicente Sotto Memorial Medical Center in carries an important responsibility for the From a medical standpoint, a woman is Cebu City. parents. They should save enough money advised to wait two or three years before Abortion cases consistently ranked for the birth of their child. However, for getting pregnant again to help the body to from among top three of Obstetrics and very poor patients, they can avail of their recover from the stress of pregnancy. Gynecology (OBGyn) admissions in the years PhilHealth membership for free given by the “Let’s stop abortion. Pregnancy 2012 and 2013. national government or the LGUs. Having a can be a welcome phase for any woman The DOH prescribes 5 R’s to put a PhilHealth card will provide free coverage of and her partner, if it comes as planned and stop to abortion: birthing expenses. without any complications,” Ona concluded. 1. READY FACILITIES – Improve- 4. RIGHT KNOWLEDGE – For - o O o -

March - April 2014 I HEALTHbeat 15 HIV/AIDS PREVENTION Condoms for Quezon City The Department of Health - confirmed AIDS cases and 197 HIV-infected cases; Pasig with 34 HIV / 4 AIDS; Makati National Capital Region (DOH-NCR) and asymptomatic males and 4 females. The with 15 HIV; Caloocan with 14 HIV / 1 AIDS; the SAMACKA (Spa’s Massage Center Club’s predominant modes of transmission were Mandaluyong with 10 HIV / 2 AIDS; Pasay, 11 and KTV’s Association) started a massive homosexual at 114 cases (51%) and bisexual HIV; Taguig with 7 HIV / 3 AIDS; Parañaque campaign for the prevention and control 88 cases (39%). Heterosexual transmission with 6 HIV / 2 AIDS; Marikina with 7 HIV / of Human Immunodeficiency Virus and with 22 cases (10%). 1 AIDS; Malabon with 6 HIV; and Las Piñas Acquired Immune Deficiency Syndrome Every two hours, a Filipino with 5 HIV / 1 AIDS; San Juan City with 4 HIV; (HIV/AIDS) in Quezon City through becomes infected with HIV/AIDS for life Muntinlupa and Valenzuela with 3 HIV cases dissemination of correct information and or a total of 13 new cases daily with NCR each; Navotas City with 2 HIV; and Pateros distribution of condoms in various massage contributing 50% of the total HIV cases in with 1 HIV case. For the whole country, a centers, clubs and KTV’s in Quezon City. the country. total of 7,843 cases were reported from 1984 “We started this campaign in Among the cities with the most to present. Quezon City because it has the most number number of HIV/AIDS cases were Quezon City The DOH-NCR has partnered of HIV/AIDS cases. And we are targeting with 54 HIV asymptomatic / 6 confirmed with the local government of Quezon City entertainment hubs in the city by providing AIDS cases; Manila with 34 HIV / 4 AIDS and various leisure businesses to work for them the proper information and an HIV-Free Quezon City. Each educating them on the prevention establishment will be given a box and control of the disease,” Health full of free condoms and flyers Undersecretary and Head of the where essential information about DOH-NCR Teodora J. Herbosa HIV/AIDS can be read. Customers stated. can get from the box strategically HIV/AIDS Registry for placed at the entrance or front January 2014 showed a total of desk. 224 confirmed cases as reported HIV affects humans only and by the STD/AIDS Cooperative a person can avoid infection Central Laboratory based at the through ABCDE: A-abstinence, San Lazaro Hospital. The figure B-be mutually faithful, C-correct is 23% higher compared to the and consistent use of condoms, same period last year with 182 D-don’t use drugs/used needles, confirmed cases. Majority (90%) and E- education, early diagnosis were asymptomatic or those who and treatment. are infected with HIV but do not “We will be flooding have symptoms of AIDS. Metro Manila with condoms if it Ages of cases ranged is the only way we can prevent from 17 - 68 years old. Most of the rapid spread of HIV/AIDS. It those affected were the 25 - 29 is a critical and the only effective years age-group. Majority were element in the prevention male. Most of the cases acquired and control of the disease and the disease through homosexual available tool in reducing the practices. Twenty-eight (28) cases transmission of sexual infections were OFWs. There were 23 male and diseases,” Herbosa concluded.

16 HEALTHbeat I March - April 2014 ORGAN donation

PUP in Sta. Mesa, Manila is expecting to set a new world record for single site registration for one hour with a total of 3,548 “PUPians” registered during the first hour of the eight-hour event, beating India’s record of 2,755 people in Ahmedabad, Guijarat on September 17 last year. I'M A LIFELINE Organ Donation Sign-Up Campaign by GLEN S. RAMOS HEALTHbeat Staff The “I'm A Lifeline,” an organ Philippines for the most number of pledges for single site registration for one hour with donation sign-up campaign of the in one day in multiple sites, namely: a total of 3,548 “PUPians” registered during Department of Health and the Philippine Polytechnic University of the Philippines the first hour of the eight-hour event, Network on Organ Sharing (PhilNOS) held (PUP) in Sta. Mesa, Manila; Quezon beating India’s record of 2,755 people in simultaneously in six sites around the Memorial Circle in Quezon City; Ilocos Ahmedabad, Guijarat on September 17 last country on February 28, 2014 registered a Training and Regional Medical Center in San year. total of 17,856 pledges to break the Guinness Fernando City, La Union; L. Mamba Gym in Dr. Antonio Paraiso, program World Records set by India. Tuguegarao; Jesse M. Robledo Coliseum in manager of DOH Philippine Network for The eight-hour one-day event Naga; and Almendras Gym in Davao. Organ Sharing (DOH-Philnos) and the lead established a new world record for the PUP Manila set a new world record organizer of the event, said, “Past records

March - April 2014 I HEALTHbeat 17 were done in universities, so we were an organ donor identification card to those make a pledge,” he said. betting on PUP to break the records. And who registered which specifies which of According to a 2013 survey by true enough, more than 3,000 signed up in their organs can be harvested. Among the the Philippine Information Agency, most PUP.” vital organs that can be donated are kidneys, Filipinos are willing to donate a part of their The number of registrants enlisted lungs, hearts, livers and pancreas, even body but only to their immediate kin and for the first hour in other areas are: La Union tissues such as corneas, bones and skin. closest relatives. with 3,471; Davao with 1,947; Tuguegarao Health Undersecretary Teodoro J. To date, PhilNOS only recorded a with 1,573; Naga with 1,532;and Quezon Herbosa, area cluster head for the National total of 12,000 patients who have undergone City with 1,270. Capital Region (NCR) and Southern Luzon renal transplants due to the limited number This unofficial tally is yet to be and concurrently the head of DOH-NCR, of organs being donated. “There are a validated by the Guinness World Records. stated that the objective of the campaign total of 100,215 people in the wait-list However, India still holds the most record was to institutionalize an initial registry of for organ transplants in the country. Most for a single site eight-hour registration at potential organ donors in Metro Manila and of these patients fail to wait for available 10,450 registrants, achieved on December 1, other areas and at the same time address the organs. Among the most needed organs for 2013 at Sir Chhotu Ram stadium in Rohtak, significant demand for organ donors in the transplantation are kidney, liver, lungs and Haryana, India. country. heart, respectively. Paraiso said that the campaign “Organ donation saves lives and it “I encourage everyone to register has brought public awareness on the is very important that every person has the and become an organ donor and help save importance and benefits of organ donation power to save a life by becoming an organ, many lives. By having more organ donors in and transplantation in the country because tissue or eye donor. It is a noble gift because the country life-saving transplantations will of the massive number of people pledging you can give someone a second chance at made possible for more patients every year”, as living organ donor. PhiNOS will provide life. Everyone is welcome to register and Herbosa concluded.

I'm A Lifeline Campaign at Quezon Memorial Circle in Quezon City led by Health Undersecretary and concurrent head of DOH-NCR Teodoro J. Herbosa (top center photo) and Dr. Antonio Paraiso, program manager of DOH Philippine Network for Organ Sharing (bottom left photo). Photos courtesy of DOH-NCR.

18 HEALTHbeat I March - April 2014 Top 10 Myths on Organ Donation SOURCE: Human Organ Preservation Effort (HOPE) of the National Kidney and Transplant Institute (NKTI)

MYTH: My body will be mutilated grief for my family. when my organs are FACT: Information about the harvested. donor is released by HOPE FACT: Donated organs are to the recipients only if removed surgically, in a the family that donated routine operation similar allows it. to gallbladder or appendix removal. Normal funeral MYTH: My religion does not arrangements are possible. support donation. FACT: All organized religions MYTH: My family would be support donation, typically expected to pay for considering it a generous donating my organs. act that is the individual's FACT: A donor's family is not choice. charged for donation. If a family believes it MYTH: Only heart, liver and kidneys has been billed incorrectly, can be transplanted. the family immediately Grabbed from HOPE-NKTI Facebook page FACT: The pancreas, lungs, should contact its local small and large intestines, organ procurement have failed and death has been and the stomach also can organization. determined. HOPE does not notify be transplanted. the transplant team until your MYTH: I might want to donate one family has consented to donation. MYTH: Wealthy people are the only organ, but I do not want to people who receive transplants. donate everything. MYTH: I am not the right age for FACT: Anyone requiring a transplant is FACT: You may specify what organs donation. eligible for one. Arrangements you want donated. Your wishes FACT: Organs may be donated from can be made with the transplant will be followed. someone as young as a newborn. hospital for individuals requiring Age limits for organ donation financial assistance. MYTH: If I am in an accident and the no longer exist; however, the hospital knows that I want to be general age limit for tissue MYTH: I have a history of medical illness. a donor, the doctors will not try donation is 70. You would not want my organs to save my life. or tissues. FACT: The medical team treating MYTH: If I donate, I would worry that FACT: At the time of death, HOPE will you is separate from the the recipient and/or the review medical and social histo- transplant team. HOPE is not recipient's family would discover ries to determine donor suitability notified until all lifesaving efforts my identity and cause more on a case-by-case basis.

March - April 2014 I HEALTHbeat 19 laughter HEALS BAWAL ANG DONASYON?!? Eh Kung... Amnesia Fingerprints

MIGZ: Naghiwalay kami ng syota ko. Sila DENZ: Pare, yung bakla sa parlor na PULIS: Nakilala mo ba ang nanakit at na ngayon ng katropa ko. nabundol kanina, nagka- nanampal sa iyo? CHRIS: 'Kapag ang ex mo napunta sa amnesia! EDNA: Hindi pero may naiwan siyang FRIEND mo, 'wag ka nang JASZ: Ha? Talaga? Eh ba't parang fingerprints! magtaka kasi napupunta ang natutulala ka? PULIS: Talaga, saan?!? basura sa PLASTIC, 'di ba? DENZ: Iniisip ko lang 'pre, ang bakla ba EDNA: Nasa pisngi ko! MIGZ: Eh kung sa kamag-anak ko kapag nagka-amnesia, bakla pa napunta ang ex ko? rin?!? Katangahan CHRIS: Ang tawag dun, SAGIP- KAPAMILYA. Disgrasya! LIZELLE: Ang tanga-tanga ko talaga at MIGZ: Eh kung sa ibang tao na hindi ko pinakasalan kita! naman kilala? RIA: Hoy, Mamang Driver, dahan- CLARENCE: Alam ko! Pero in-love ako sa CHRIS: Ang tawag dun ay DONASYON. dahan naman sa pagpapatakbo iyo noon kaya hindi ko nalang ng jeep mo! Alalahanin mo na pinansin ang pagkatanga mo. Plane Crash laging may nakasunod sa atin na disgrasya! Bakasyon PILOTO: ...And please fasten your DRIVER: Eh, kaya ko nga binibilisan seatbelt. We will make an para hindi tayo abutan! CLAR: Kamusta ang long weekend emergency crash landing. vacation mo sa probinsya n'yo? JOAN: (Nagpa-panic, biglang tumayo Tinik DAKS: Masama. Biyernes, napilay ang at sumigaw...) Ako'y babae, manok ni Tiyong, ang ulam namin nais kong ma-experience ang KRISTAL: 'Nay natinik po ako ng isda! ay tinola. Sabado, napilay ang dapat ma-experience ng isang LUZ: Naku! Heto anak, uminom ka baboy, ang ulam namin litson. babae bago bumagsak ang ng tubig... Nung Linggo, napilay si Tiyong, eroplanong ito! Mayroon ba KRISTAL: 'Nay meron pa din po eh. hindi ko na inalam ang ulam, sa iyong magpapatunay na LUZ: O eto, kumain ka ng kanin. kumain ako sa labas at diretso ako'y isang ganap na babae? KRISTAL: Nay! Nandito pa rin. na kong lumuwas. JR: (Tumayo, lumapit sa babae at LUZ: Lumunok ka nitong saging, dahan-dahang hinubad ang huwag mong ngunguyain, ha. kasuotan at sinabing...) KRISTAL: Wala pong nangyari, Inay. Babae, ito ang damit ko, LUZ: Saan ka ba natinik? labhan mo! KRISTAL: Sa talampakan po.

20 HEALTHbeat I March - April 2014 Post-Yolanda REHABILITATION

Professional Responsibility & Unifying Power of Care and Compassion LESSONS FROM YOLANDA

The aftermath of Super Typhoon Yolanda caused severe damage newborn, child health and nutrition) Yolanda can be described as great chaos. beyond belief to the health facilities, and recounted, “On the eve of the typhoon People everywhere were confused and in health professionals lamented that the and as part of our preparations, we were great panic because of the level of damage progress they have made in maternal and assigned to the mobile disaster response the typhoon brought. Everyone thought child health in Leyte was abruptly impaired. team. We were sent home early on Thursday they were prepared, until Yolanda left them Thirty-three (33) out of 41 municipalities, in order to get back to our duties as soon in utter disbelief, in the appalling morning have hospitals, RHUs, and barangay health as Yolanda subsides. Unfortunately, we of November 8, 2013. stations that were either partially or totally never expected that the typhoon would The Department of Health’s Center damaged, and several equipment provided leave the province destroyed and almost for Health Development-Eastern Visayas and by the JICA SMACHS-EV Project were all government agencies dysfunctional. We the Leyte Provincial Health Office (PHO), washed out. On the other hand, amidst loss started off cleaning up our office and the together with the Strengthening Maternal and destruction, the health professionals Leyte Provincial Hospital. Despite several and Child Health Services in Eastern Visayas learned meaningful lessons, especially on obstacles, we tried our best to resume our (JICA SMACHS-EV) Project, immediately professional responsibility and the unifying RHU activities. We were also victims of initiated improving access to safe pregnancy power of care and compassion. Yolanda, yet we continued to report and and delivery, and postpartum care services in provide services to show our commitment to the Yolanda-devastated Leyte. As the result Professional Responsibility the people. We are responsible for the health of this collaborative effort, health facilities of our constituents and we must do the best became ready to provide the services with Professional Responsibility is often we can. We must persevere. Right now, we the necessary equipment placed in rural taught among professionals, but they often are hoping that the PHO will be back to its health units (RHUs) and district health do not reflect on it or just take it for granted. usual, if not better or even the best, status centers. Health service providers – doctors, But devastating events like Yolanda make ever.” nurses, and midwives – have been trained one discover its relevance. Dr Ofelia C. Absin (acting provincial to competently provide Basic Emergency At Leyte PHO, Dr Edgardo Daya health officer 2) asserted, “I am grateful that Obstetric and Neonatal Care (BEmONC) (provincial health officer 1) and Marina the employees continue to report, even if up services for maternal and child health. Alvaran (provincial coordinator for maternal, to now they are roofless or homeless. Indeed,

March - April 2014 I HEALTHbeat 21 it was a life-changing experience. Bayan Member on Health, who We have come to realize that are doctors, as well as a physician everything is temporary and from Eastern Visayas Regional that life is precious. We are now, Medical Center came to our aid. more than ever, motivated to Aside from our staff, a large help save lives by providing the number of health volunteers utmost quality health care services reported to lend a hand. On the throughout Leyte.” succeeding weeks, one by one, At Tanauan RHU, Tita international aid came, such as Margallo (public health nurse) the Medecins Sans Frontieres, shared, “We literally had to fight Save the Children, Republic for our lives as we tenaciously of Korea, UN Population Fund clung on mattresses in order to (UNFPA), Hope Worldwide remain afloat when the dark Philippines, among others. Both seawater surged into the facility and rose Dutch, Canadians, among others. The foreign and local teams have helped us out, to almost two meters high. Yes, we may unifying power of care and compassion particularly in doing medical missions in all have faced death but it never kept us from accelerated the recovery and reconstruction accessible barangays. So far, the experience shaking out the fear and getting back to our after the tragedy. was deeply moving. responsibilities as health care providers. This Dr Arlene Santo, (municipal health With so many people injured, lots experience kept us driven and motivated to officer of Tanauan, Leyte) recalled, “After the of volunteers came forward to share their help and serve, as more and more injured typhoon, we were left with only betadine time and help; even one midwife who just people came seeking for medical attention.” and meager medical supplies to tend to our lost a daughter came back to work after patients; we even made use of cellophane a few days. Despite the difficulty in food, Unifying Power of strips in place of bandages to manage cuts water, transportation and communication, Care and Compassion and wounds. We did not have facilities people sacrificed for their fellowmen and and instruments, and the supplies were that experience was really overwhelming.” After Yolanda, local and running doubly low. I could even vividly The disaster changed Leyte and international organizations arrived to recall that pregnant women were forced to sent the province lunging into deep chaos. provide the needed emergency support. deliver their babies on chairs without any Facilities and services were left dysfunctional To ensure proper coordination among privacy. We really felt helpless with the and people were drawn to a seemingly government, development partners and devastation. Nevertheless, the increasing endless darkness. Although people have international health groups, the Health number of people seeking our help kept us gone through a dark and rough time, there is Cluster Meeting was initiated and managed moving. Luckily, on November 10, a medical a ray of light at the end of it all. Professional by the World Health Organization. The team from California came and set up an responsibility and unifying power of care meeting was composed of different emergency area where we were able to do and compassion served as a beacon of light nationalities, including Mexicans, Italians, surgeries and normal deliveries. that will take health professionals out of the Japanese, Americans, Ethiopians, Spanish, Our Vice Mayor and Sangguniang dark.

DOH/JICA SMACHS-EV Project Through the Department of Health Center for Health Development in Eastern Visayas (DOH-CHD EV), the Philippine Government collaborated with Japan International Cooperation Agency (JICA) and launched the Project for Strengthening Maternal and Child Health Services in Eastern Visayas, more known as SMACHS-EV Project. The Project is a four-year undertaking that commenced in June 2010 until June 2014 as an initiative and commitment of the government to promote the achievement of the Millennium Development Goals, particularly in reducing maternal and child mortality by 2015. For more information, please visit http://www.facebook.com/machi.ev or contact (053) 323-6114 or [email protected].

22 HEALTHbeat I March - April 2014 Post-Yolanda REHABILITATION

Tindog Visayas by PAULYN JEAN ROSELL-UBIAL, MD Area Cluster Assistant Secretary for Visayas

Many events have transpired in regions. As the rehabilitation period the Department of Health’s long 115 years A few months after the fateful continues to unfold, the DOH shines through history, but the events that unfolded at day, the DOH looks back to assess what by sowing its commitment and drive to serve early dawn of November 8, 2013 will surely went right and what went wrong. Each of without giving much thought about the go down as a “shining moment” for the the more than 5,000 health responders who risk, danger and discomfort of going to the Philippines premiere health agency. came to the devastated areas hit by Yolanda devastated areas, but rather just thinking Days before the strongest tropical have their stories to tell, both harrowing and that our mere presence with our vests with storm in recorded history made landfall, the heartwarming. the big bold D-O-H letters printed at the entire agency, headed by Health Secretary I have heard so many such stories back is already a reassurance to survivors and Enrique T. Ona, had already been planning because of my role as the Cluster Head of local health workers that there is hope. We and prepositioning logistics, supply, cash the Visayas Regions. Coming in and out of are there to help them get back on their feet, and human resources in areas that were the affected areas, going there almost every “TINDOG VISAYAS” – stand up VISAYAS or rise forecasted to be affected. Then, it hit Guiuan, week since Yolanda hit, I am awed by the up Visayas from the debris and devastation Eastern Samar at 4 am with packing winds human spirit, the resiliency of the people, the of Yolanda. of more than 375 kilometers per hour, and generosity of donors, and the compassion The DOH can see the indomitable it moved in the archipelago making five and heart of the responders. These are stories spirit of the people in the Visayas emanating more landfalls in the Visayas and MiMaRoPa that should be told time and again. to the rest of the world.

March - April 2014 I HEALTHbeat 23 CLOCKWISE: With World Health Organization's Regional Director for the Western Pacific Director Dr Shin Young-soo (fourth from left) at Eastern Visayas Regional Medical Center for assessment of situation and plan for continued support from WHO... Inside the Peace Ark, the Chinese Navy Hospital Ship... At Ormoc OPCEN (Operation Center)... At Barangay Paglaum, Tacloban City - a hard-to-reach area with Korean volunteers.

#PHthankyou Alina Chung-Harpern is a 7-year old Phil- British who told the invited guests to her birthday party in December 2013 not to bring gifts, but cash so that she can send the amount to the Philippines and provide gifts to children affected by Super Typhoon Yolanda. On February 14, 2014 her request was granted when Health Assistant Secretary Paulyn Jean Rosell- Ubial and Dr. Glo Fabrigas of the mayor’s office in Tacloban City went to far-flung Barangay Paglaum to distribute the gifts bought from the cash collected by Alina. The children who received gifts sent Valentine’s and Thank You cards for Alina.

24 HEALTHbeat I March - April 2014 Post-Yolanda REHABILITATION

President Benigno S. Aquino III and Health Secretary Enrique T. Ona led the ceremonial groundbreaking of the new site for the state-of-the-art Eastern Visayas Regional Medical Center (EVRMC) in Barangay Cabalawan, Tacloban City on February 25, 2014. (Photo by Paking Repelente) EVRMC Rising by DONATO DENNIS B. MAGAT HEALTHbeat Staff “F--k you, Yolanda!” These words, high as 21 feet. Death toll reached 6,240. The most written on one of the walls along the main As of March 4, 2014, data from number of fatalities were recorded in Eastern road in Tacloban City, clearly epitomize the National Disaster Risk Reduction Samar (5,808) followed by Western Visayas the sentiments of the people about Super and Management Council revealed that (329), Central Visayas (74), MIMAROPA Typhoon Yolanda that struck their province 3,424,593 families were displaced by region (23), CALABARZON region (3), Bicol on November 8, 2013. Yolanda has been super typhoon Yolanda. The Department of Region (2), and a lone fatality at CARAGA called the most powerful storm to make Health reported 571 damaged facilities in region. As of 26 February 2014, bodies were landfall in recorded history reportedly MiMaRoPa, Western Visayas, Central Visayas, still being found in Tacloban City. carrying a maximum sustained winds of up and Eastern Visayas regions amounting to During the storm surge, more than to 270 kph and a storm surge reaching as P730,989,000. half of the city’s establishments, including

March - April 2014 I HEALTHbeat 25 Health Secretary Enrique T. Ona (left) together with Eastern Visayas Regional Medical Center (EVRMC) Officer-in-Charge Dr Cirilo Galindez (right) who was in the center of chaos when Super Typhoon Yolanda severly damaged the last hospital standing in Tacloban City. Galindez is no stranger to disasters. In the right photo during the aftermath of magnitude 7.8 killer earthquake in the early '90s, he made quite an impression on President Cory Aquino when he satisfactorily handled the situation as the assistant provincial health officer of Kayapa District Hospital in Nueva Vizcaya. health care facilities, were damaged. After has saved a lot in restoring hospital government, donor agencies, and the DOH. about three to four days of no food or even properties. To date, EVRMC has repaired/ A graduate of medicine at the water, looting became the order of the day. restored about 25 beds and about 30 still University of the East Ramon Magsaysay In the midst of all the chaos in the province, to be repaired. An OB delivery bed worth Memorial Medical Center in 1978, the Eastern Visayas Regional Medical Center P300,000 has also been restored. Galindez Galindez is no stranger to disasters. During (EVRMC) did not close its doors to people said, as of March 4, 2014, the entire roof and the aftermath of magnitude 7.8 killer seeking medical attention. ceiling of the EVRMC were already repaired earthquake in the early '90s, he made quite According to EVRMC Officer-in- and repainted. Likewise, the retiling of an impression on President Cory Aquino Charge Dr Cirilo Galindez, the hospital was the hospital’s first floor has been finished. when he satisfactorily handled the situation not spared of the havoc caused by Yolanda. Significantly, the pungent smell in the as the assistant provincial health officer of In fact, most of the roof, ceiling, windows hospital is already gone. Kayapa District Hospital in Nueva Vizcaya. and doors were blown away by the strong Foremost, the morale of the wind and rain. The resources of the hospital, employees has been boosted. All employees From 14-Bed Capacity including two ambulances, two generators, are working as a team with their hospital to Ultra Modern EVRMC laundry equipment, x-ray machines director. They have now overcome the state including CT scan, medical equipment, files of desperation and trauma resulting from The Eastern Visayas Regional Medical and other records were submerged and the tragedy. Because of Galindez’s knack and Center (EVRMC), then known as the Leyte washed away by the 7-feet storm surge. dedication in saving limited resources, as Provincial Hospital, first opened its doors to Galindez estimated the damage to EVRMC at evidenced by the restoration of the EVRMC, the public in July 16, 1916 at Jones Street approximately P250M. he has been tasked for another assignment with an authorized bed capacity of 14. However, all is not lost for EVRMC. which is the repair/restoration of a rural With increasing demand, the hospital was Galindez and some selected staff are doing health center at the San Jose district of relocated to its present site at Magsaysay everything to repair, reconstruct and Tacloban, the hardest hit by Yolanda. The Boulevard in 1925. refurbish all equipment and beds damaged initial estimate to repair the structure was In 1972, a bill was filed to increase the by the Yolanda. The acting director, more placed at P1M. Funding for equipment hospital’s bed capacity and change its name often dubbed as the “King of Restoration,” and other apparatus will be from the local to Speaker Daniel Z. Romualdez Memorial

26 HEALTHbeat I March - April 2014 Hospital Memorial Hospital (SDZRMH). This The hospital’s vision is to be a to the progress and development of medical bill became a law in July 22, 1972. In 1973, Center of Excellence for Health Care, Training services in the Region and elsewhere; the DOH designated the hospital as a regional and Research – making available the establish a creative and rewarding work teaching hospital with an authorized bed highest quality of multi-disciplinary health environment for its personnel, empowering capacity of 250. Aside from being the only care and professional training in the medical the organization at every level so as to teaching and training hospital in Eastern and paramedical disciplines to the people of ensure the highest level of service excellence Visayas, it is also the end referral hospital of Region 8. to the people it is mandated to serve; and all government hospitals in the Region. The On the other hand, its mission is establish linkages with other government, ensuing years were witness to the growth of to: provide essential health, medical and non-government, professional and civic the hospital in terms of infrastructure and social services to all the people in Region 8 at organizations necessary to the pursuit of its service delivery. affordable cost with priority to the needs of goals. After the EDSA revolution in 1986, the underprivileged, the sick, the disabled, Although the EVRMC was severely SDZRMH was renamed Tacloban City Medical the elderly, the women, the children, damaged by Yolanda, it was the last hospital Center (TCMC) per Memorandum Order No. the victims of disasters, armed conflict, standing in Tacloban City because it never 48 of the Office of the President. On March illiteracy and geographic distance; serve closed after the tragedy. Through it all, 24, 1992 by virtue of Republic Act No. 7879, as training venue and implement training the hospital staff remained focused and TCMC was renamed as the EVRMC, and was programs for medical, paramedical, allied committed to their tasks. They never faltered designated as the regional teaching-training health professionals and student affiliates; and always placed the welfare of the patients hospital with the three-pronged mandate of conduct/participate in relevant, quality and before their own personal needs staying true service, teaching-training, and research. ethical health research that will contribute to the EVRMC mission and vision. Despite

Eastern Visayas Regional Medical Center Officer-in-Charge Dr Cirilo Galindez is already being dubbed as “King of Restoration” as he saved a lot in restoring hospital properties. As of 4 March 2014, the entire roof and ceiling of the EVRMC were already repaired and repainted. Likewise, the retiling of the hospital’s first floor has been finished. Significantly, the pungent smell in the hospital is already gone. (Photos by Paking Repelente)

March - April 2014 I HEALTHbeat 27 the 250-bed capacity of EVRMC, a review of have an initial funding of P500M from the The 2013 ARTA results reported 168 the hospital’s daily census for the period of DOH. The event was well-attended by local government offices rated excellent, while 67 November 7-29, 2013 recorded the number officials, cabinet secretaries, and donor failed. Out of the 929 total offices surveyed of patients ranged from 125-346. partner agencies. last year, 620 are national government Health Secretary Enrique T. Ona “The existence of hospitals and offices including the Department of Health. was touched by the dedication of the its operation is synonymous to saving a Among hospitals, the National Center for officers and staff to fulfill their mandate. He thousand lives during disaster,” Ona said, Mental Health and Valenzuela Medical disclosed that hospitals should always be a “hence the government will be building a Center was rated “Excellent” with a grade haven for the distressed and refuge for the hospital that can withstand the test of time of 90-100%. A "Good" rating (89-89.9%) afflicted. It is for this reason that the EVRMC like the new ultra-modern EVRMC.” was awarded to the Cagayan Valley Medical will be transferring to a new site which is Meanwhile, the EVRMC was Center, Adela Serra Ty Memorial Medical about a meter higher than the national road recently recognized by the 2013 Anti-Red Center, Batangas Regional Hospital, and away from the shore which will make it Tape Act (ARTA) Report Card Survey Results Jose R. Reyes Memorial Medical Center, safer from future storm surges. in improving efficiency in the delivery of Southern Philippines Medical Center, Culion On February 25, 2014, during the government service to the public by reducing Sanitarium, Rizal Medical Center, Basilan 28th year observance of the EDSA People bureaucratic red tape and preventing General Hospital, Don Jose Monfort Medical Power, President Benigno S. Aquino III led graft and corruption. It was awarded an Center, CARAGA Regional Hospital, Paulino the ceremonial groundbreaking for the new “Acceptable” rating (70-79.9%) alongside J. Garcia Memorial Research and Medical location of the EVRMC. The new EVRMC will Tondo Medical Center. Center, and Don Emilio del Valle Hospital. www.healthbeat.ph www.facebook.com/DOH.HEALTHbeat.ph www.doh.gov.ph Photo by Joerem P. Ceria

28 HEALTHbeat I March - April 2014 stress RELIEF Kayod Lang

Breaking News Mayor Barbero

ISANG TRAK, Dumalaw si Mayor sa Mental Hospital... BARBERO: Sir ano pong gupit? NAWALAN NG KONTROL, DOK IVAN: Let's welcome our Mayor... RAUL: Yung uka-uka, masagwa NAHULOG SA BANGIN, MGA PASYENTE: (Pumalakpak maliban sa at hindi pantay! NABUHAY ANG DRIVER... isa na nasa sulok...) BARBERO: Hindi ko yata alam 'yan! MAYOR: O, dok, bakit 'yung isa, RAUL: Anong hindi?!? Ganyan REPORTER: Nakainom ka ba, Mamang hindi pumalakpak? kaya ang gupit mo sa akin Drayber? DOK IVAN: Magaling na po kasi siya! last time! JOEL: Oo nman! Anong palagay mo sa akin, STUNTMAN?!? Attorney Pharmacist

Tricycle Drayber ATTY: Habang pinapanood mong GRACE: Meron po ba kayong inumin ng asawa mo ang gamot para sa putok Nagkataon, nagkasabay ang mag-ex sa kapeng may lason, hindi ka man sa kilikili? tricycle... lang ba naawa sa kanya kahit PHARMACIST: Opo. Meron po. DRAYBER: Miss, saan po kayo bababa? isang beses?" GRACE: Bakit hindi ninyo JOJI: Brgy. Bigay, Sitio Kuha, ELLEN: Naawa naman po... ginagamit? Ubos Biyaya, Change Syota. ATTY: At kailan `yon? DRAYBER: Sir, saan po kayo bababa? ELLEN: 'Nung humingi siya ng isa pang Kasambahay DANNY: Brgy. Tamang Hinala, tasa ng kape. Minahal Mo ng Tama, AMO: Hoy Chari, bakit tuwing Ikaw pa Masama! Titser dumadating ako, inaabutan JOJI & DANNY: Magkano po? kitang nanonood ng TV? DRAYBER: Bitter, mahigit kumulang TITSER: What is the capital of the CHARI: Eh Ma'am, ayaw ko hindi mabilang, parehas Philippines? nama na maabutan ninyo kayong nagkulang, walang AURORA: Ma'am. Kahit ako Intsik, ako ako na walang ginagawa! kwentang pinagsamahan. alam Pilipinas. Pilipinas, wala Bente pesos lang. capital, pulo utang. Pangit

Pulis Pulubi DENNIS: Pare, ang babaeng pangit ay parang lalaki. JULIAN: Mamang pulis, awatin po RIA: Hindi ba ikaw yung may sakit PAKING: Batkit mo naman ninyo ang itay ko! na namamalimos sa simbahan? nasabi yun? PULIS: Sino ba d'yan sa dalawang PULUBI: Oo. gumaling na ako. DENNIS: Kailangan niyang nag-aaway ang tatay mo? eh bat malungkot ka? magtrabaho JULIAN: Yan nga po ang pinag-aawayan RIA: Eh paano pa ko mamalimos, nang husto nila! gumaling nako? para mabuhay.

March - April 2014 I HEALTHbeat 29 HEALTH facilities POC Modernization by DR. WILLIE T. ONG Reprinted from the Philippine Star Digital Edition, February 22, 2014 One of the controversial issues in rendered. For the new POC, government This is written explicitly in the contract, health is the modernization of the Philippine will retain ownership of the hospital, will which the private sector must follow. This is Orthopedic Center (POC) to become the continue to regulate services and will get to correct false reports that only 10% will be Philippine Rehabilitation Center under the majority of charity beds for the poor. Hence devoted to charity. government's Public-Private Partnership these three points make it very different (PPP) program. Because of the complexity from the old privatization scheme. How the Private Sector Will Benefit of the issue, the public has not been getting The government will retain the correct information on the matter. ownership of hospital, and this is the most The private sector has 30% or 210 important difference between privatization private beds and can earn money from the Facts Concerning the New POC and PPP. private cases, without putting the poor at The government will also regulate a disadvantage. The private sector does not POC will not be privatized. the services given. The DOH will head a need to spend much for marketing because Some groups are claiming that POC will governing council that will oversee how it will get the POC branding already. be privatized. This is simply not true. To the hospital is run. The government is not Orthopedic cases are on the rise explain briefly, privatization means that the relinquishing control to the private sector. because of the aging population. Hence, government sells a property and lets the The government is assured of 70% high technology surgeries, implants and private group dictate the price and services or 490 PhilHealth-Charity beds for the poor. treatments will now be offered to all Filipinos. Everyone can potentially benefit from having a modern orthopedic center. Efficiency can give rise to profits by performing operations quickly and safely. The new POC can serve an estimated four times more patients.

How Government and the Poor Will Benefit

New building and facilities built at no cost to the government and the people’s taxes. These infrastructures are built quickly in two years. Otherwise, Filipinos will have to wait 15-20 years if and when a modern POC would be built. With the present budget, there is no way P5.6 billion can be spent on one hospital alone. Poor patients will get quality care and medical costs will be shouldered Photos grabbed in the Internet. Credit to David Montasco Snapshots (top) and change.org (bottom). by PhilHealth. These patients will now

30 HEALTHbeat I March - April 2014 be operated on faster because of hospital efficiency. At present, patients at the old POC stay an average of 22 days in the hospital. In a world class and efficient facility, the average hospital turnover will be reduced to 4 to 5 days only. Thus, four times more poor patients can be served in the new hospital.

Why Some Groups are Opposing

The main reason for the opposition to the new POC is the fear of losing jobs. The DOH has repeatedly assured the employees On February 14, 2014 at the Manila Hotel, Health Secretary Enrique T. Ona, together with Philippine that no one will lose their jobs. Orthopedic Center (POC) Officer-in-Charge Dr Jose Pujalte, Jr. and Philippine Medical Association However, Health Secretary Enrique President Dr Leo Olarte, stressed to media that no employee will lose his/her job at the Philippine Orthopedic Center (POC). Ona added that employees are given three options either to quit government T. Ona explained that the employees will service and join the new corporatized POC, stay at the old POC establishment which will be utilize as a have three options: 1) to quit government rehabilitation center or opt for an early retirement. Moderating the forum are former senator Joey Lina service and join the new corporatized POC; and Rolly Gonzalo of DWIZ.(Photo by Paking Repelente) 2) stay at the old POC establishment which will be utilize as a rehabilitation center or; we don’t go into this PPP project, I see no manage it as a fully government-run facility. 3) opt for an early retirement. It is foremost way for the POC to be modernized in the next “I believe that in 25 years, in the DOH’s goal that poor patients will be 15 to 20 years. Are we willing to wait for that thousands of Filipinos would already have guaranteed medical services and will not be time and let our patients continue to suffer?” benefitted from the new POC. I will not be turned away. In 25 years, the PPP contract will around to witness it anymore. But I want to Ona said, “We have learned the expire and the modernized POC will be assure everybody that I have tried my best, lessons of PPP in other countries. We have returned to the government. By that time, with the resources we have, to improve the studied this contract meticulously to ensure in the year 2039, the government will have delivery of health services for our people,” that the poor will not be disadvantaged. If the option to continue the contract, or to Ona concluded. KALAbeat Management Position Habang naglalakad ang isang sa binata at pagalit na sinabing, “Dito inyo kapag hindi kayo magsipag sa trabaho!” mataas na opisyal sa mga opisina ng kanilang binabayaran ko ang mga empleyado para Nilapitan ng opisyal ang isa sa ospital, may napansin siyang isang binata na magtrabaho at hindi para tumayo lamang mga empleyado at tinanong, “Sino ba ‘yung nakasandal sa pader at walang ginagawa. sa isang tabi at magpapogi. Heto ang binatang sinisante ko?” At Nilapitan niya ito at marahan na tinanong tatlong buwan sahod mo, at LUMAYAS KA sinabi ng empleyado, “Sir, ang binata, “Magkano ang sinasahod mo sa DITO AT HUWAG KA NANG BABALIK!” Agad- tagahatid po ‘yun ng isang buwan?” Nagtatakang sumagot ang agad namang kinuha ng binata ang pera at lunch na inorder binata, “Kumikita po ako ng P6,000 isang nagmamadaling umalis. namin sa isang buwan. Bakit po, Sir?” Napansin ng opisyal na marami restaurant na Inilabas ng opisyal ang kanyang ang nakatingin sa kanya kaya mariin niyang malapit dito sa wallet at kumuha ng P18,000 cash, ibinigay sinabi, “At ganyan din ang mangyayari sa ospital!”

March - April 2014 I HEALTHbeat 31 Muslim HEALTH Marijuana and Medical Necessity by TATO M. USMAN, MD, MPAIM DOH - Autonomous Region in Muslim Mindanao Marijuana ingested in food or drink. an average of 8 points in IQ between age 13 However, if it is ingested, THC and age 38. Importantly, the lost cognitive Marijuana refers to the dried acts on specific molecular targets on abilities were not fully restored in those who leaves, flowers, stems, and seeds from the brain cells, called cannabinoid receptors. quit smoking marijuana as adults. Those who hemp plant Cannabis sativa, which contains These receptors are ordinarily activated by started smoking marijuana in adulthood did the psychoactive (mind-altering) chemical chemicals similar to THC that naturally occur not show significant IQ declines. delta-9-tetrahydrocannabinol (THC), as well in the body (such as anandamide) and are Marijuana use may have a as other related compounds. part of a neural communication network wide range of effects, particularly on Marijuana is usually smoked in called the endocannabinoid system. This cardiopulmonary and mental health. hand-rolled cigarettes (joints) or in pipes system plays an important role in normal Marijuana smoke is an irritant to or water pipes (bongs). It is also smoked brain development and function. the lungs, and frequent marijuana smokers in blunts –cigars that have been emptied The highest density of cannabinoid can have many of the same respiratory of tobacco and refilled with a mixture of receptors is found in parts of the brain that problems experienced by tobacco smokers, marijuana and tobacco. Marijuana smoke influence pleasure, memory, thinking, such as daily cough and phlegm production, has a pungent and distinctive, usually sweet- concentration, sensory and time perception, more frequent acute chest illness, and a and-sour, odor. Marijuana can also be mixed and coordinated movement. Marijuana heightened risk of lung infections. One study in food (like brownies) or brewed as a tea. overactivates the endocannabinoid system, found that people who smoke marijuana When marijuana is smoked, causing the “high” and other effects that frequently but do not smoke tobacco have THC rapidly passes from the lungs into the users experience. These effects include more health problems and miss more days of bloodstream, which carries the chemical altered perceptions and mood, impaired work than those who don’t smoke marijuana, to the brain and other organs throughout coordination, difficulty with thinking and mainly because of respiratory illnesses. It is the body. It is absorbed more slowly when problem solving, and disrupted learning and not yet known whether marijuana smoking memory. contributes to risk for lung cancer. Marijuana also affects brain development, and when it is used heavily Health Risks Still Outweigh Benefits by young people, its effects on thinking and memory may last a long time or even Many have called for the be permanent. A recent study of marijuana legalization of marijuana to treat conditions users who began using in adolescence including pain and nausea caused by HIV/ revealed substantially reduced connectivity AIDS, cancer, and other conditions, but among brain areas responsible for learning clinical evidence showed the health risks still and memory. And a large long-term study in outweigh its therapeutic benefits. New Zealand showed that people who began According to the US National smoking marijuana heavily in their teens lost Institute on Drug Abuse (NIDA), to be

32 HEALTHbeat I March - April 2014 considered a legitimate medicine by the in the next verse: Food and Drug Administration (FDA), a Satan’s plan is to sow hatred and substance must have well-defined and enmity amongst you with intoxicants and measurable ingredients that are consistent gambling, and to hamper you from the from one unit (such as a pill or injection) to remembrance of Allah and from prayer. Will the next. As the marijuana plant contains you not give up? (Qur’an 5:91) hundreds of chemical compounds that may The said verse tells us how it have different effects and that vary from is a detestable act of Satan, because plant to plant, and because the plant is intoxicants apart from sowing the seeds of typically ingested via smoking, its use as enmity also stop you from the sole purpose a medicine is difficult to evaluate. of having been sent to the world, namely However, THC-based drugs to the remembrance of Allah Almighty. treat pain and nausea are already FDA Bear in mind that when the term approved and prescribed, and scientists intoxicant is used it also encompasses continue to investigate the medicinal narcotics, because they to among other properties of other chemicals found in the things result in the loss of self-control. cannabis plant – such as cannabidiol, a non- 4.8-fold increase in the risk of heart attack There are also many Hadiths stated psychoactive cannabinoid compound that is in the first hour after smoking the drug. This by the Prophet (peace and blessings be upon being studied for its effects at treating pain, risk may be greater in older individuals or in him or pbuh) in regards to intoxicants. pediatric epilepsy, and other disorders. those with cardiac vulnerabilities. A number of studies have linked Additionally, because it seriously 1) Jabir (may Allah be pleased with chronic marijuana use and mental illness. impairs judgment and motor coordination, him) reported that the Prophet (pbuh) High doses of marijuana can produce a marijuana contributes to risk of injury or said, "Whosoever drinks wine, whip temporary psychotic reaction (involving death while driving a car. A recent analysis him. If he repeats it for the fourth time, hallucinations and paranoia) in some users, of data from several studies found that kill him." He (Jabir) says, A man was and using marijuana can worsen the course marijuana use more than doubles a driver’s later brought to the Prophet (Peace and of illness in patients with schizophrenia. A risk of being in an accident. The combination blessings be upon him) who had drunk series of large studies following users across of marijuana and alcohol is worse than either wine for the fourth time. He beat him, time also showed a link between marijuana substance alone with respect to driving but did not kill him. (Tirmidhi, Abu use and later development of psychosis. impairment Dawood). This relationship was influenced by genetic variables as well as the amount of drug used, Islamic View on Intoxicant The following Hadith clearly drug potency, and the age at which it was states that the Prophet (pbuh) prohibited first taken – those who start young are at In the Noble Qur’an, Allah intoxicants: increased risk for later problem Associations Almighty states: have also been found between marijuana O You who believe! Intoxicants 2) Ibn Umar (may Allah be pleased with use and other mental health problems, such and gambling, (dedication of) stones and him) reported that the Messenger of as depression, anxiety, suicidal thoughts (divination by) arrows are an abomination Allah (pbuh) said, "Every intoxicant is among adolescents, and personality of Satan’s handiwork. Avoid (such abomina- khamr (intoxicant) and every intoxicant disturbances, including a lack of motivation tions) that you may prosper. (Qur’an 5:90) is haraam (unlawful). Whosoever drinks to engage in typically rewarding activities. Allah Almighty has described wine in this world and dies whilst Marijuana also raises heart rate by intoxicants amongst other things as being consumed in it and does not repent will 20-100 percent shortly after smoking; this appalling, despicable and hateful acts of not drink it in the next world. (Muslim) effect can last up to 3 hours. In one study, it Satan and he has commanded us to abstain was estimated that marijuana users have a from them, Allah Almighty thereafter states 3) Jabir (may Allah be pleased with

March - April 2014 I HEALTHbeat 33 him) narrates that a man came from Dawood and Ibn Majah) necessary for preserving life. In support Yemen and asked the Prophet (pbuh) of their position that prohibited food about a wine made from corn called 6) Umme Salmah (may Allah be pleased substances may be used as medicine, they ‘Mizr’, which they drank, in their with her) narrates that the Messenger of argue that the Prophet (pbuh) allowed land. The Prophet (pbuh) asked, "Is it Allah (pbuh) prohibited every intoxicant `Abdur-Rahman ibn `Awf and Az-Zubayr intoxicating?" He replied, "Yes" The and Mufattir (anything which excites ibn Al-`Awwam to wear silk because they Prophet (pbuh) said, "Every intoxicant is and irritates the mind, body and heart). were suffering from scabies. (The text of this unlawful. Verily there is covenant upon (Abu Dawood) Hadith is quoted in the subsection of this Allah for one who drinks intoxicating book entitled "Clothing and Ornaments.") drinks, that he will make him drink From the above Hadiths, we can Perhaps this latter view is from ‘Teenatul Khabal,’ they asked, "O clearly see the Prophet (pbuh) and the closer to the spirit of Islam which, in all messenger of Allah, what is Teenatul Islamic view regarding intoxicants. its rules and teachings, is concerned with Khabal?" He said, "The sweat of the the preservation of human life. However, inmates of hell or the pus (of impurities) Is it Lawful for a Muslim to taking medicine containing some haram of the inmates of hell." (Muslim) Use Marijuana as Medicine? (prohibited) substances is permissible only under the following conditions: 4) Abdullah ibn Umar (may Allah be Islam cares much for the well- pleased with him) reports that the being of its followers. It never allows a 1. The patient's life is endangered if he Prophet (pbuh) said, "Whosoever drinks Muslim to destroy himself or others or cast does not take this medicine. wine, Allah will not accept his prayer for himself into destruction by his own hands. 40 days. If he seeks repentance Allah This is clear in the so many Hadiths of the 2. No alternative or substitute will forgive him. And if he repeats it Prophet (pbuh) and so many Qur'anic verses. medication made from entirely halal Allah will not accept his prayer for 40 The prominent Muslim scholar (lawful) sources is available. days. If he seeks repentance Allah will Sheikh Yusuf Al-Qaradawi wrote in his book forgive him. And if he repeats it again The Lawful and the Prohibited in Islam, 3. The medication is prescribed by a Allah will not accept his prayer for 40 under the title “Medical Necessity”: Muslim physician who is knowledgeable days. If he seeks repentance Allah will Concerning the question of as well as Allah-fearing. forgive him. If he repeats it for the fourth whether some of the prohibited food time Allah will not accept his prayer for substances (like pig meat or ingredients) can Understandably, marijuana sub- 40 days. If he seeks repentance Allah be used as medicine, there is a difference of stances can be used for treating diseases by will not accept it and he will be made to opinion among jurists. Some do not consider Muslims under medical necessity according drink from the river of impurities (of the medicine as belonging to the category of to Sheikh Yusuf Al-Qaradawi provided that inmates of hell). (Tirmidhi, Nasai, Ibn a compelling necessity like food, and in those three conditions are met. Moreover, Majah and Daarami from Ibn Amr) support of their position they cite the Hadith: it should be cleared that such therapeutic "Assuredly Allah did not provide a cure substances extracted from marijuana must 5) Jabir (may Allah be pleased with him) for you in what He has prohibited to you." be isolated and studied thoroughly based narrated that the Messenger of Allah (Reported by Al-Bukhari on the authority of on evidence-based that it has excellent (pbuh) said; "Whatever intoxicates in Ibn Mas`ud.) therapeutic values compared to halal a greater quantity is also unlawful in Others consider the need for (lawful) substances. its smaller quantity." (Tirmidhi, Abu medicine equal to that of food, as both are Allah Almighty knows best.

Natatandaan mo pa ba 'yung sinabi ko noon na, "Laughter is the best medicine?" Kalimutan mo na 'yun, Junior. Bibili nalang tayo ng medical marijuana.

34 HEALTHbeat I March - April 2014 dangerous DRUGS Dangerous Drugs Board on Medical Marijuana

Marijuana, reports of its appealing for the legalization of marijuana medical use, and the clamor for its – their plea ranging from legalization, legalization has been a significant decriminalization, and medical marijuana. topic of public discourse in the country. As In terms of policies, however, these three several countries in Europe and states in terms are not synonymous. America amend their drug laws to either Marijuana legalization generally decriminalize or legalize both medical and refers to laws or policies which make recreational use of marijuana, appeals possession and use of marijuana legal under for legalization in the Philippines also the law. Decriminalization on the other intensify. hand, refers to laws or policies which With the safety, health and reduce the penalties for possession and well-being of the Filipinos at stake, the use from criminal sanctions to may be Dangerous Drugs Board (DDB) is very fines or civil penalties. careful in reviewing and enacting Medical marijuana, which has policies relative to drug prevention been the popular argument of and control. Given the immense many, allows for an individual to danger marijuana poses and absence defend oneself for criminal charges if of studies or researches that would marijuana is used as a form of treatment concretely define its positive health effects, or medication. the DDB strongly opposes the legalization of There has also been a public marijuana for medical use. substances bring about subjective changes misconception that “smoked marijuana” in consciousness and mood that may include is synonymous with “medical marijuana.” About Marijuana euphoria, calmness, anxiety, and paranoia. As mentioned in the earlier section of this Other psychological effects include distorted paper, marijuana contains a number of Marijuana is the term used to sense of time, magical or “random” thinking, chemicals. Not all of these components describe all plant materials like leaves, tops, short-term memory loss, and depression. have been reported to have medicinal value. stems, flowers, and roots from the plant The risks of marijuana also go up with heavy Among these is the psychoactive component Cannabis sativa. use, often leading to addiction. THC, which has also been proven by many There are over 480 components studies to have harmful effects. found within the Cannabis sativa plant, Clamor for Medical Marijuana THC must be extracted from of which 66 have been classified as marijuana for it to be used as medication. “cannabinoids,” chemicals unique to the Following the recent enactment of Like all other medications, a strict clinical plant. The most well-known of these is the laws in Europe, Uruguay, and several states scrutiny by the Department of Health-Food delta-9-tertrahydrocannabinol or THC, the in the United States of America legalizing and Drug Adminstration (DOH-FDA) that substance primarily responsible for the not only the medical but also recreational must also be conducted. psychoactive effects of cannabis. use of marijuana, calls to do the same in the Does the government disregard Results of several studies on Philippines sparked. new medications containing chemicals marijuana reveal that psychoactive There are a number of groups from marijuana? No. In fact, the DDB has

March - April 2014 I HEALTHbeat 35 referred to the DOH-FDA a medication, • Marijuana has certain adverse health the second most abused drug in the country Sativex, submitted to DDB for clearance. effects that must also be taken into (2012 Nationwide Survey by age group, Sativex, administered through oral spray account. 10-69 Years Old, on the Current Nature and for treatment of muscle spasm, has THC Under the 1961 United Nations Extent of Drug Abuse in the Philippines). component. The matter is now referred to (UN) Single Convention on Narcotic Drugs, the the DOH-FDA for clinical evaluation. Marijuana is placed under Schedule I. Marijuana Legalization Generally, Schedule I drugs have no medicinal in Other Countries Reported Medical Uses of Marijuana use and with high addictive potential. Several countries such as Canada, Marijuana, specifically its THC Marijuana Abuse in the Philippines Netherlands, and Israel have legal programs component, has been reported to have use for growing medical marijuana but do not in the following medical cases. Statistical data from Drug allow cultivation for recreational use. • management of neuropathic pain Treatment and Rehabilitation Centers in the In the US, legalization of marijuana caused by certain types of nerve injury Philippines reveal that before the advent of started in 1996. Right now, a total of 20 • bolstering appetite for patients with methamphetamine or shabu, marijuana was states allow the use of medical marijuana eating disorders or anorexia the most abused drug in the country. with different implementing requirements. • treatment of nausea for cancer During the 1980s, most patients Two among these states, Colorado and patients undergoing chemotherapy admitted in treatment and rehabilitation Washington, have recently passed ballot • treatment for insomnia centers were marijuana users. It was only in initiatives to legalize and regulate the Clinical studies to support these the 1990s when it was overtaken by shabu. recreational use of marijuana. claims, however, are still insufficient. Marijuana use, however, still continued. Uruguay, however, received Also, proclamations of leading medical A downward trend in the the most public attention on the issue institutions and international drug control admission to treatment and rehabilitation of marijuana legalization, when they bodies confirm otherwise. centers of both shabu and marijuana users passed a legislation completely legalizing In their public policy statement has also been seen. This may be attributed to marijuana from cultivation, distribution, and in April 2010, the American Society of the efforts of the government in drug abuse consumption. Addiction Medicine dismissed the concept prevention and control. Uruguay’s move has elicited of medical marijuana. According to the At present, marijuana still ranks as support from groups pushing to abolish National Institute on Drug Abuse, cannabis Comparative Trends of Shabu and Marijuana (MJ) Users from 1986 to 2012 fails to meet the standard requirements for (Drug Rehabilitation Centers Data) approved medicines. It is associated with many serious, well-documented, negative health effects. The US Food and Drug Administration also cited several reasons for not allowing medical marijuana. These are the following: • There have not been enough clinical trials showing that marijuana’s benefits outweigh its risks in patients with symptoms it is meant to treat. • To be considered a legitimate medicine, a substance must have well-defined and measurable ingredients that are consistent from one unit to the next.

36 HEALTHbeat I March - April 2014 prohibition of marijuana but also opposition from international drug control bodies like the United Nations.

International Drug Control Bodies on Marijuana Legalization

The head of the United Nations Office on Drugs and Crime (UNODC), Yuri Fedotov, regarded Uruguay’s move to legalize marijuana as a strike against international cooperation. Fedotov said that confronting illicit drugs and their impact is dependent on pursuing a comprehensive response to the problem based on health, long-term security, development and institution- building. The move comes ahead of a special session on the ongoing world drug problem, to be held at the UN General Assembly in 2016. The International Narcotics Control Board (INCB), an independent and quasi- judicial monitoring body mandated to implement UN international drug control conventions, said that the legislation to legalize production, sale and consumption of marijuana for non-medical purposes approved in Uruguay contravenes the 1961 Single Convention on Narcotics Drugs, to which Uruguay is a party. INCB also noted that Uruguayan policymakers failed to consider the negative impacts on health which confirm that marijuana is an addictive substance with serious consequences and long term development implications.

DDB on Medical Marijuana

In the absence of new laws and DOH-FDA authorization based on scientific clinical studies, medical use of marijuana is still illegal in the Philippines.

March - April 2014 I HEALTHbeat 37 tobacco CONTROL Why Tobacco Industry's CSR is Fake CSR Guilt is No Better than Greed by ANTHONY R. RODA, MaHeSoS HEALTHbeat Staff Is it alright for a company that needs to be responsible for its actions – Health Organization (WHO), “CSR is crucial manufactures or provides a consumer socially, ethically and environmentally. to the tobacco industry for restoring its product or service that can endanger health CSR policies and programs seek to benefit damaged reputation, improving employee and life to perform social responsibility society while simultaneously improving the morale and maintaining and increasing the activities? company’s public image and profitability. value of company.“ This is the question raised and The term is often criticized for simply being Atty. Alexander Padilla, president answered in the workshop conducted by a public relations buzzword. Some argue of the Philippine Health Insurance the Department of Health’s National Tobacco that it is merely window-dressing, or an Corporation (PhilHealth) and still one of the Control Coordinating Office lodged at the attempt to pre-empt the government’s role DOH tobacco control focal points, has once Health Promotion and Communication as a watchdog over powerful multinational put it, “There’s no such thing as CSR as far as Service (formerly National Center for Health corporations. tobacco companies are concerned. They just Promotion) for tobacco control officers Tobacco is the only legal use that to promote their product and make of government agencies and civil society product that, when used according to the even larger profits.“ Meanwhile, Dr Ulysses groups nationwide on February 27 and 28, manufacturers’ instructions, kills or causes Dorotheo of the Southeast Asian Tobacco 2014 in Tagaytay City. disease in more than half of the people who Control Alliance (SEATCA) stressed, “CSR does Corporate Social Responsibility use it. Yet tobacco companies often use CSR many things, but the biggest of them all is it (CSR) is a corporate belief that a company to cover up this fact. According to the World influences policy makers.”

Tobacco control officers from the Department of Health, Department of Education, Department of Social Welfare and Development, Civil Service Commission, Metro Manila Development Authority, HealthJustice Philippines and Framework Convention on Tobacco Control Alliance Philippines bonded together for the Fake CSR workshop on February 27-28, 2014 in Tagaytay City. Dr Mary Assunta Kolandai, Senior Policy Advisor for the Southeast Asia Tobacco Control Alliance (seated in the front row, fourth from left), graced the workshop as resource speaker.

38 HEALTHbeat I March - April 2014 The CSR activities of tobacco companies are vast and varied. In public health, they engaged in programs like youth smoking prevention, information campaigns on the harms of smoking, reduction of public harms associated with tobacco use such as establishment of dedicated rooms for smokers, and even support to sporting events. Tobacco companies also involve themselves in: disaster response and relief operations; environment programs like tree planting and litter reduction; education programs like scholarship, establishment or refurbishing of libraries or school facilities; and cultural programs like beauty contests and support for music, fashion, journalism, theater and other art programs.

Policies Against Tobacco Industry's CSR

The Framework Convention on Tobacco Control (FCTC), the first and only public health treaty under the WHO which Cartoon by Grant Hocking (2005). Protecting consumer health is now clearly mentioned in ISO 26000. Companies cannot harm their customers’ health, let alone kill them. the Senate ratified and entered into force in the country in September 2005, seeks to possible, regulate activities described as CSR. However, in the absence of a national to protect present and future generations ‘socially responsible’ by the tobacco industry, law, tobacco control advocates insist that the from the devastating health, social, including but not limited to activities Philippines must adhere to the FCTC. This is environmental and economic consequences described as ‘corporate social responsibility.’” where local policies play an important role. of tobacco consumption and exposure to FCTC Article 13 recognizes that a In 2010, the Civil Service tobacco smoke" by enacting a set of universal comprehensive ban on tobacco advertising, Commission (CSC) and the Department standards stating the dangers of tobacco and promotion and sponsorship would reduce of Health issued a groundbreaking joint limiting its use in all forms worldwide. The the consumption of tobacco products. It memorandum that seeks to protect FCTC recognizes that the tobacco industry is recommended that Parties or countries the bureaucracy from tobacco industry uses CSR to interfere with government should ban contributions from tobacco interference. It covers all government tobacco control measures. companies to any other entity for “socially officials and employees, regardless of status, FCTC Article 5.3 states: “In setting responsible causes”, as this is a form of in the national or local government including and implementing their public health sponsorship. Publicity given to “socially government-owned and -controlled policies with regards to tobacco control, responsible” business practices of the corporations, state colleges and universities.” parties shall act to protect these policies tobacco industry should be banned, as it The joint memorandum prohibits from commercial and other vested interests constitutes advertising and promotion. government officials and personnel from of the tobacco industry in accordance with Currently, under Republic Act interacting with the tobacco industry except national law.” In one of the Conference 9211 or the Tobacco Regulation Act of 2003, when strictly necessary for the latter’s of Parties to implement the FCTC, there regulation of the tobacco industry pertains effective regulation, and bars them from have been recommendations for public only to matters of advertising and smoking soliciting, accepting, “directly or indirectly, officials to “denormalize, and to the extent bans. There are no provisions relating to any gift, gratuity favor, entertainment, loan

March - April 2014 I HEALTHbeat 39 or anything of monetary value in the course promotes worldwide proprietary, industrial clearly mentioned in ISO 26000. Companies of their official duties or in connection with and commercial standards, has created in cannot harm their customers’ health, let the operation being regulated by, or any 2010 the ISO 26000 – the most prominent alone kill them. transaction which may be affected by the social responsibility guidance. Jalal said that CSR activists around functions of their office from any person or ISO 26000 defines socialthe world have concluded that tobacco business related to the tobacco industry.” responsibility as the "responsibility of companies are doing “CSR-washing” which The memorandum that specifically an organization for the impacts of its is defined as “cases where organizations deals with activities branded as “socially decisions and activities on society and claim to be more socially responsible than responsible,” requires public officials to the environment, through transparent they really are.” Tobacco control advocates in report any information on any interaction and ethical behavior that contributes to Southeast Asia have agreed to call it “FAKE” with and offer of donation from the tobacco sustainable development, health and the CSR. industry as well as preferential treatment welfare of society. It takes into account the Aside from tobacco companies given to the latter. Any violation of this expectations of stakeholders; is in compliance not being eligible for ISO 26000 standards, memorandum "shall be considered a ground with applicable law and consistent with representatives of tobacco companies for administrative disciplinary action international norms of behavior; and is are also banned from speaking about pursuant to Rule XIV of the Omnibus Rules integrated throughout the organization and CSR, including business ethics, in most Implementing Book V of Executive Order practiced in its relationships.” international seminars since 2004. Tobacco No. 292, without prejudice to the filing of Careful examination of ISO companies –along with alcohol, gambling, criminal as well as civil actions under existing 26000 reveals that tobacco companies armaments, and adult entertainments – laws, rules and regulations.” cannot fulfill the guidance’s principles and are excluded from socially responsible and expectations related to its core subjects. The ethical investment indexes. Global expert ISO 26000: Social Responsibility ISO 26000 Principles of Social Responsibility surveys, like SustainAbility and GlobeScan, are: accountability, transparency, ethical also reveal that tobacco industry cannot be Jalal, a CSR activist based in behavior, respect for the stakeholders, considered as responsible industry. Indonesia, introduced ISO 26000 to respect for the rule of law, respect for Sharing one's blessings is Southeast Asian tobacco control advocates International norms of behavior, and commonly practiced by the inherently in a SEATCA workshop in Cambodia in human rights. On the other hand, the ISO religious Filipinos. But what if these blessings October 2013. He said tobacco companies 26000 Core Subjects are: organizational come from the guilt of greedy persons or deploy social activities to gain the governance, human rights, labor practices, institutions, would you still accept them? image of socially responsible companies. the environment, fair operating practices, National and local governments as well However, the International Organization community involvement and development, as charitable institutions should be aware for Standardization (known as ISO), an and consumer issues. and beware of CSR activities of tobacco international standard-setting body that Protecting consumer health is now companies because these are just FAKE CSR!

www.beat-tobacco.ph

40 HEALTHbeat I March - April 2014 heart HEALTH

5 servings of fruits and vegentables ; 2 hours screen time (TV/computer/gadgets); 1 hour of moderate physical activity; 0 sugary beverages; and 0 smoking. Philippine Heart Association urges, LET'S DO THE 52-100 Cardiovascular disease (CVD), servings of fruits and vegetables; have a people should eat healthy, watch less and primarily heart attack and stroke, remains maximum of TWO hours of screen time exercise more to prevent obesity, which is the number one cause of mortality in (TV/computer/gadgets); perform ONE risk factor for CVD. Equally important is to the Philippines. It affects people from hour of moderate physical activity; have emphasize that people should not start different age groups and usually happens ZERO sugary beverages such as soda and smoking or quit smoking. in individuals in their productive years. CVD sweetened juices (drink more water); and “The PHA also believes that CVD is not just a disease that we may inherit ZERO to smoking.” starts in the young, therefore, prevention from our parents, but a lifestyle-induced In a nutshell, 52-100 stresses that should start during childhood. The 52- disease, meaning it can be acquired due to 100 focuses primarily on kids but can be compounded poor lifestyle habits. It has practiced by adults as well. In fact, the been noted that CVD patients are getting whole family should adopt it since heart- younger. healthy lifestyle is a family affair. Eating The Philippine Heart Association and drinking wisely, regular exercise, no to (PHA), the leading organization of soda and sweetened drinks, as well as no cardiovascular specialists in the country, is to smoking should be ingrained in the kids’ promoting the 52-100 Lifestyle Prevention minds while they are in their formative as the key in curbing the global epidemic of years. It is hard to lick a healthy regimen that heart and vascular diseases. had long been embedded in their system,” PHA Director and concurrent added del Rosario. Advocacy Committee Chair Dr Jonas del He also said that as cardiologists, Rosario announced that the “Let’s do the they always stress that daily physical 52-100” is the new tagline of the Association activity, like running at least one hour, helps that will relentlessly harp on to promote a strengthen your heart. Running or any form heart-healthy lifestyle. of exercise should be a family activity. Sad Del Rosario says, “52-100 is your Dr. Jonas del Rosario, director of the Philippine to say, children do not go outdoors to play. daily code to a healthy heart. Everyday, Heart Association and concurrent Advocacy Nowadays, most children are so addicted to let us practice the 52-100: Consume FIVE Committee chair. virtual games in their cellphones, tablets

March - April 2014 I HEALTHbeat 41 and PCs. This is not good for the heart. They schools should provide the programs and The PHA intensely promotes 52- have to be encouraged to do short amounts infrastructure to allow more physical activity 100 and urges the public to practice this of activity several times a day until they add in communities. healthy formula. After seeing and feeling up to 60 or more minutes each day. “The PHA strongly prescribes the results, pass it on. Do your testimonial, Del Rosario stressed that physical the 52-100 formula because an ounce of he added. activity should be fun – dancing, running, prevention is better than a pound of cure. Despite setbacks, the PHA took biking, hiking or even doing household You don’t contract heart disease overnight. on the World Heart Federation challenge to chores. Exercise does not have to be limited The healthy heart seed begins in the womb work on the 2025 goal – to reduce premature to playing sports although having one is and nurturing is an endless process,“ said cardiovascular death by 25 percent, Reyes really encouraged. The government and PHA President Dr Eugene Reyes. concluded.

More DOH Hospitals to Care for the Heart

At the start of the Heart Month (February), the (122) coronary angiogram; (21) coronary angioplasty; (35) Department of Health reported that there will be additional permanent pacemaker implantation; (8) replacement of pulse government hospitals that are capable of performing heart generator; (1) internal cardioverter defibrillator; (9) temporary surgeries, where three are already operational. This, as the DOH pacemaker insertion; (7) intra-aortic balloon pump insertion; (12) reiterates its Pilipinas Go4Health campaign which encourages hemodynamic studies (pedia); (31) radiologic procedures, among Filipinos to practice healthy lifestyle by making a personal others. commitment to physical activity, proper nutrition and the The NMMC, also in Mindanao, did 5 cases of heart prevention or cessation of smoking and alcohol intake – to control surgeries on March 22-23, 2013with 2 cases of children with PDA the prevalence of heart and vascular diseases. (Patent DuctusArteriosus), 1 case of atrial myxoma and 2 cases of “A patient need not travel to Manila just to be operated VSD (Ventricular Septal Defect). on. We now have a number of DOH-retained hospitals which are Meanwhile,the BRTTH in Southern Luzon has a record capable to perform heart procedures with comparable expertise of numerous angiographic procedures done with 30 in 2008; 39 and precision, at much lower rates”, Health Secretary Enrique Ona in 2009; 76 in 2010; 76 in 2011; 100 in 2012 and a total of 39 for said. the first quarter of 2013. Majority of the cases handled were for Aside from specialty hospitals like Philippine Heart coronary angiogram. Center, other DOH hospitals that conduct open heart surgeries The DOH reported that cardiovascular diseases remain and transplants are Region 1 Medical Center (R1MC) in Dagupan, to be the top cause of mortality in the Philippines with 120,000 Pangasinan; Bicol Regional Teaching and Training Hospital (BRTTH) Filipinos dying due to lifestyle-related diseases (i.e. cardiovascular, in Legazpi, Albay; Northern Mindanao Medical Center (NMMC) stroke, hypertension,kidney problems and diabetes) per year. in Cagayan de Oro, Misamis Oriental and Southern Philippines “The government is determined to achieve Kalusugan Medical Center (SPMC) in Davao City. Pangkalahatan for all Filipinos through state-of-the-art The SPMC in Davao City, which follows the Philippine technologies,health facility improvements and health promotion Heart Center on the number of heart surgeries performed, has from the northernmost part of Luzon to Visayas to the farthest done a total of 1,158 catheterization procedures from 2007 to south of Mindanao. This development will definitely decongest the January 2014. For 2013 alone, SPMC has done (215) CV-cathlab; Philippine Heart Center”, the health chief concluded.

42 HEALTHbeat I March - April 2014 HEALTHY diet Photo grabbed from the Internet

Hey, Sugar!

Readying New Global Policy For example, one tablespoon of ketchup throughout the life-course. Although contains around 4 gram (around 1 teaspoon) exposure to fluoride reduces dental caries Is the sugar-coated world we live in of sugars. A single can of sugar-sweetened at a given age, and delays the onset of the coming to a better end or at least drastically beverage or soft drink contains up to 40 cavitation process, it does not completely reduced for better health, especially for the gram (around 10 teaspoons) of sugar. prevent dental caries. Dental caries still new and next generations? The new draft guideline progresses in populations exposed to On March 5, 2014 from its recommends the following: fluoride. headquarters in Geneva, the World Health • reduced intake of free sugars The recommendations, however, Organization (WHO) held a virtual press throughout the life-course; do not apply to individuals in need of conference for journalists around the globe • intake of free sugars not exceeding therapeutic diets, including those for the to call in and preview the draft guideline on 10% of total energy In both adults management of severe, moderate and limiting the consumption of sugars to reduce and children; and acute malnutrition. Specific guidelines public health problems, particularly obesity • further reduction of free sugars to for management of severe, moderate and and dental caries . below 5% of total energy. acute malnutrition are being developed The term “sugars” includes: Below 5% of total energy intake separately. “intrinsic sugars” – those incorporated within per day which is equivalent to around 25 The draft guideline was formulated the structure of intact fruit and vegetables; grams (around 6 teaspoons) of sugar for an based on analyses of all published scientific “sugars from milk” – lactose and galactose; adult of normal Body Mass Index (BMI) will studies on the consumption of sugar and and “free sugars” – all monosaccharides have additional benefits. how that relates to excess weight gain and and disaccharides added to foods by the Moreover, the recommendation tooth decay in adults and children. manufacturer, cook or consumer, plus sugars to further limit free sugars intake to less The new guidance on sugar naturally present in honey, syrups and fruit than 5% of total energy is further based consumption is in response to research juices. The WHO said that because there is no on the recognition that dental caries tracks documenting its deleterious effects. The evidence of adverse effects of consumption from childhood to adulthood. In order to WHO stated, “There is increasing concern of intrinsic sugars, recommendations focus minimize lifelong risk of dental caries, the that consumption of free sugars, particularly on the effect of consumption of free sugars. consumption of free sugars should be as low in the form of sugar-sweetened beverages, Most of the sugars consumed as possible. may result in both reduced intake of foods today are “hidden” sugars in processed foods No harm is associated with containing more nutritionally adequate that may or may not usually seen as sweet, reducing the intake of free sugars to less calories and an increase in total caloric such as soft drinks or sodas, snacks and than 5% of total energy, particularly intake, leading to an unhealthy diet, weight sauces, that are often targeted at children. when considering the risk of dental caries gain and increased risk of NCDs.”

March - April 2014 I HEALTHbeat 43 The recommendations in the new guideline can be used by program managers and policy planners to assess current intake levels of free sugars relative to a benchmark, and to develop measures to decrease free sugars intake, where necessary, through public health interventions such as food and product labelling, consumer education, and the establishment of food-based dietary guidelines.

Pushing for a National Policy

Meanwhile, at the halls of Congress in the Philippines, there is a bill that bans Photo courtesy of DOH-National Capital Region soft drinks and other sugar-laden drinks in Consumer Health schools and require canteen operators to provide free potable water to protect the Flouride Toothpastes health of school children. This was filed The 2006 National Oral Health use: and (4) promoting the use of effective by House Representatives Leni Robredo of Survey showed that among public elementary fluoride toothpaste twice a day is strongly Camarines Sur and Arlene Bag-ao of Dinagat school students, 97.1% of six-year old children recommended. Islands on February 26, 2014. The lawmakers suffer from tooth decay. Four out of every In the Philippines, daily school- together with 10-year old Daniel Gatmaytan five children of this subgroup manifested based fluoride toothbrushing in pilot school who has been campaigning to ban soft symptoms of dentinogenic infection. In studies have resulted in 40% caries reduction drinks in schools, filed House Bill 4021 or the addition, 78.4% of 12-year old children suffer and in 60% reduction of caries progression proposed Healthy Beverage Options Act of from dental caries and 49.7% of the same age into the pulp. 2014 on February 26, 2014. group manifested symptoms of dentinogenic There are 26 brands of toothpastes The bill seeks to ban the following infections. The severity of dental caries, containing fluoride that are notified with expressed as the average number of decayed, the Department of Health - Food and Drug beverages in schools: soft drinks, sports missing and filled (DMFT) was 8.4 for the six- Administration. These fluoride toothpastes drinks, punch, iced tea and fruit-based drinks year-old age group and 2.9 for the 12-year old come in different flavors, packaging sizes that contain less than 50 percent real fruit age group. and prices that are appropriate to the family juice or that contain additional sweeteners In a systematic review of literature budget. These are: Aekyung; AP-24; B&B as well as drinks containing caffeine, on fluoride toothpastes and mouth rinses by Kids; Botanica; CHC; Chicco; Cliven; Close excluding low-fat or fat-free chocolate milk. Cochrane Collaboration Oral Health Group, up; CNI Winz; Fast; Fluocaril; Formula; Glee; On the other hand, beverages such as fruit- fluoride toothpastes reduced the DMFT 3-year Happee; Hello Kitty; Herbal Fresh; Master based drinks that contain at least 50 percent increment (number of new dental caries Kids; Naturacentials; Oral-B; Pepsodent; fruit juice and do not contain additional developing over 3 years) by 23%. The World Sensodyne; Stanhome; Victoria Court; sweeteners; water and seltzer, and low-fat Health Organization and the FDI World Dental Xyloclens; and Zacts. or fat-free milk, including chocolate milk, Federation in 2007 clearly state that: (1) Parents are encouraged to buy prevention of tooth decay by using fluoride is fluoride toothpaste for their family. With soy milk, rice milk and other dairy and non- the most realistic way of reducing the burden regular brushing of teeth, fluoride toothpaste dairy calcium-fortified milks are to be sold in of tooth decay in population: (2) fluoride helps reduce the risk of dental carries which schools. toothpaste remains the most widespread have negative efforts on their growth and The bill also mandates canteen and significant form of fluoride used globally educational outcomes in children operators to provide potable water for free and the most rigorously evaluated vehicle for For more information or clarifica- to students and school personnel. fluoride use: (3) fluoride toothpaste is safe to tion please email [email protected]

44 HEALTHbeat I March - April 2014 HEALTH award

Josephine L. Guiao (second from left) of the DOH's Health Facilities and Services Regulatory Bureau receives NDAP's Nutritionist-Dietitian of the Year award. Josephine L. Guiao, RND, MSCN Nutritionist-Dietician of the Year Josephine L. Guiao, dietary and regulations affecting government 11-15, 2013 in Jakarta, Indonesia, Guiao was adviser (Development Management Officer nutritionist-dieticians. Her diligence earned recognized as Second Outstanding Alumna IV) of the Department of Health - Health her scholarships abroad to further hone her of SEA-NLP Alumni Award. Moreover, her Facilities and Services Regulatory Bureau skills; her competencies, selflessness and "Re-Echo Training of the 9th SEA-NLP in the (formerly National Center for Health Facility tireless energy in health promotion and Philippines" which was held in San Mateo, Development or NCFHD) is awarded the advocacy, networking and communication Rizal on July 8-12, 2013 garnered an award 2013 Nutritionist-Dietician of the Year by the of nutrition and health programs has for the DOH-NCHFD as the successful conduct Nutritionist-Dieticians' Association of the likewise merited citations from many of country project. Philippines (NDAP) during its 59th Annual sectors. Her support and services to various The aim of the SEA-NLP is to Convention on February 26-27, 2014. NDAP committees since 1995 have also been empower postgraduate level nutritionists, Guiao is given that distinct truly remarkable. by providing competencies in effective recognition for amplifying the capability of a Meanwhile, during the 10th leadership and forum for networking among nutritionist-dietician in a leadership position (Jubilee Year) South East Asian Nutrition nutritionists in the region. to positively impact policies, standards Leadership Program (SEA-NLP) on November - o O o -

March - April 2014 I HEALTHbeat 45 HEALTH news Prophecy Fulfilled?!? The Alleged Flesh-Eating Disease in Pangasinan Explained Did the ABS-CBN news report mysterious disease (misteryosong sakit). health facility, has now completed the aired in February 2014 actually fulfil the The country woke up the following treatment but may still need debridement prophecy of the self-titled prophet Vincent day with the growing buzz about the for her skin lesions. The patient is now being Selvakumar of the Voice of Jesus Ministries mysterious disease and the fear of a prophecy assessed on current drug reaction and for in April 2013 about a flesh-eating disease beginning to be fulfilled. The Department of work-up for tuberculosis. that would spread from Pangasinan to the Health and the Pangasinan Provincial Health The Provincial Health Officer rest of the world? The prophet also allegedly Office immediately belied the rumors. also checked on the reported Case (2) from predicted the flood that would ravage Samar In a press statement, Health Villasis, Pangasinan. Clinical examination and Leyte which some people believed to Secretary Enrique T. Ona said, “There is no confirmed that the patient has a case of have been fulfilled when Super Typhoon reported case of ‘flesh-eating’ skin disease in severe psoriasis, a chronic skin disease Yolanda hit the Central Philippines on the country yet. Absolutely no reason for the characterized by red patches covered with November 8, 2013. public to panic.” white scales. Bandila, ABS-CBN's late night Health officials reported that Case “There are a lot of diseases that news program, aired on February 24 the story (1) was of a female, 21 year old, from Sta. may manifest through changes in the skin. by Jasmin Romero who was seen wearing Barbara, Pangasinan who is on multi-drug It is good to consult our doctors or go to the protective gear and mask interviewing two therapy for leprosy at a regional health unit. nearest barangay health unit when we need patients from the Pangasinan towns of Dr Myrna Cabotaje, DOH Regional Director in medical advice and treatment. Let us avail Villasis and Sta. Barbara and described them Ilocos Region, added that the said patient, of the free healthcare service in our health as having decaying (naagnas) skin due to a who was initially-treated in another private facilities,” Ona reminded the public. On February 27, the state- run Philippine News Agency (PNA) reported that residents of Pangasinan were demanding a public apology from ABS- CBN for airing a story that caused public hysteria. And in a 30-second segment of Bandila, anchor Julius Babao read the statement of apology in Tagalog saying, Bandila apologizes that their report about the two separate cases of a skin-disease caused a mass panic especially in Pangasinan and that the ABS-CBN Office of the Network Ombudsman is investigating what happened. Babao added that the ABS-CBN assures that Screen grab of ABS-CBN's Bandila news report. there would be actions taken

46 HEALTHbeat I March - April 2014 according to the results of the investigation. Mobile Health On March 2, the PNA reported that Gov. Amado Espino Jr. dared the TV station to prove its sincerity by helping repair the Leprosy Alert and damage that had been done to the province. The governor learned that many tourists Response Network System going to the Hundred Islands cancelled their reservations in hotels and inns, causing a As part of the drain in the locals’ incomes. The number of country's observance pilgrims going to Manaoag was reported of World Leprosy Day to have been drastically reduced in the first (January 29), the weekend of March, and the locals said their Department of Health, friends refused to touch and eat freshly Philippine Council for grilled milkfish. Health Research and On March 4, ABS-CBN’s TV Patrol Development, Novartis reported that the Sangguniang Panlalawigan Healthcare Philippines, of Pangasinan passed a resolution which Novartis Foundation for seeks for a more sincere public apology Sustainable Development From left to right: Health Assistant Secretary Enrique A. Tayag, from the network. The resolution stated that and local information Christine Fajardo - corporate affairs and market access director of the flesh-eating disease report "hurt and technology company Novartis Healthcare Philippines and Health Secretary Enrique T. severely affected the commerce and tourism Metahelix launched Ona .(Photo by Paking Repelente) industry in Pangasinan such that several the Leprosy Alert and local and foreign tourists have cancelled their Response Network System (LEARNS), technologies in enhancing the quality of trip and hotel reservations in the province the country’s first mobile phone-based healthcare in the country,” said Christine not to mention also the big losses incurred leprosy referral system on February 3, Fajardo, corporate affairs and market by vegetable and fruit dealers and other 2014. access director, Novartis Healthcare businessmen in the province." The resolution LEARNS is designed to work Philippines. further stated that the news report "likewise within and complement existing leprosy Aside from case finding, LEARNS caused a dent on the reputable image of control and monitoring initiatives of the also provides disease surveillance, adverse Pangasinan as a safe haven for tourists and DOH and National Leprosy Control Program drug reaction reporting, treatment investors." The provincial board also noted (NLCP). Through its innovative mobile outcome reporting, message broadcasting, that the Psoriasis Society has expressed health (mHealth) platform, LEARNS patient education, and report generation. dismay over the news report "as its members will enable healthcare practitioners to LEARNS is the latest initiative of the claim that psoriasis is not a dreaded disease refer possible leprosy patients by simply DOH-Novartis Task Force for Leprosy, a that must be feared by the people." sending a picture of the skin lesion and public-private partnership that aims to ABS-CBN Corporate Communi- patient details through their mobile promote alliances and identify innovative cations Spokesperson Bong Osorio reiterated phone. post-elimination strategies in line with the public apology aired in "Bandila" last “LEARNS will be valuable in the broader roadmap of the DOH-NLCP. February 27 and posted subsequently on identifying new leprosy cases, particularly Consistent with this year’s World Leprosy abs-cbnNEWS.com, and added that "ABS- in areas where health access is restricted Day theme “Joining Forces – Accelerating CBN assures the people of Pangasinan because of poor communications and Progress”, LEARNS harnesses partnerships that it recognizes the province's economic geographic isolation,” said Dr. Ernesto and cutting-edge technology for the final contributions to the country, and respects its Villalon, NLCP Manager. push towards the goal of a world without history and cultural heritage." As a leader in innovation, leprosy. - o O o - Novartis explores the use of new - o O o -

March - April 2014 I HEALTHbeat 47 community HEALTH

Measles dito! Measles doon! Pabakuna po... by GRACE ARCEO MALUBAG Quezon City Health Department

NANAY: Pwede po bang magpabakuna ng measles? HEALTH Misis, may bakuna na po yang WORKER: anak n’yo ng measles, kumpleto na dito sa card. NANAY: Wala pa po kasi sabi ng nars, sa tigdas daw ‘yun at hindi sa measles.

Noong mga unang araw ng bagong taon, dinagsa ng mga nanay ang mga health center dahil sa mga balitang lumalabas sa media na may outbreak ng measles. Kung dati ay 30 katao lamang ang pumupunta sa health center, ngayon ay umaabot na sa 80. Isang dekada na ako sa community DOOR-TO-DOOR SUPPLEMENTAL IMMUNIZATION ACTIVITY SA QUEZON CITY. Sa kasagsagan ng outbreak service sa local government unit (LGU). ng tigdas nitong mga unang linggo ng 2014, maraming magulang ang naalarma sa dami ng kaso Malamang naka-50 pairs na ang naisuot ng tigdas at sila na mismo ang kusang nagtungo sa health center para mabakunahan ang kanilang mga anak may edad na 9-11 na buwan para sa unang dose ng measles vaccine. Kapag wala outbreak, kong rubber shoes at white shoes, at naka-5 pahirapan naman ang mga health workers sa pagpilit na mabakunahan ang mga bata. (Litrato mula pairs na din ako ng black shoes. Nakadami na sa DOH-NCR) din ako ng bili ng sunblock. Natuto rin akong pumunta sa derma, hindi para magpabata Minsan, may isang senior citizen na Unang taon ko pa lang sa serbisyo, (besides, bata pa naman ako – batang- pumunta sa Health Center at ang akala ko nagho-home visit na ako, for follow-up visits isip), kundi para magpaalis ng sunog sa Flu ang gusto niyang ipabakuna. Ang sabi ba, para madagdagan ang accomplishment mukha. Pero hindi tungkol sa pag-itim ng niya, “Anak, hindi Flu, tigdas sana.” namin para sa Fully-Immunized Child kutis ko ang kuwento kong ito, kundi sa mga Nakakatuwa ang sitwasyong (FIC). Napakahirap kayang mag-follow batang nagsasakripisyo upang matuto ang ito, pero sa totoo lang, maraming tao ang up ng multo, este ng bata, kaya kailangan maraming tao. naaalarma sa dami ng kaso ng tigdas at pati talagang may ebidensya na totoo yung nasa Kadalasan dumarami ang na rin ng mga namamatay dito. Kahit nga Target Client List ko, at syempre para hindi kaso ng tigdas tuwing tag-init, ngunit 16-year old na ang anak, gusto pa rin ipila ng magka-kaso ng tigdas sa area ko. Natatakot ngayon, Nobyembre at Disyembre pa lang ibang nanay sa listahan ng magpapabakuna din ako syempre magka-outbreak kasi kami naglabasan nang bigla ang mga may kaso ng tigdas. ang nasisisi kapag marami ang kaso ng ng tigdas – mga bata at may matatanda pa. Eh bakit ngayon lang? tigdas. Lagot sa kinauukulan: hindi na nga

48 HEALTHbeat I March - April 2014 ako ma-regular, hindi pa ako mare-renew. ninyo patay na yan.” Meron din namang mga matinding init ng araw. Kaya naman madalas akong nanay na, bawal daw sa religion nila ang Katatapos lang ulit naming mag- magsipag-sipagan sa mga tamad na nanay magpa-injection. Kung sobrang pilosopo Supplemental Immunization Activity; hindi na hindi nagpapabakuna laban sa tigdas lang ako sasagutin ko din sana na bawal na naman kami naka-100% sa aming target para sa kanilang anak na 9 months old siyang magpa-check up pag nagkasakit, dahil sa maraming katuwiran ng mga nanay. pataas. Pero kahit anong sipag at bola ko, bawal din sa religion ko na natanggapin siya. Lilipas na naman ang mga taon, at sana lang hindi ko pa rin mabakunahan lahat ng dapat At marami pang dahilan ng 'yung 10% na hindi namin nabakunahan mabakunahan. katamaran. Pero minsan may nagsasabi din ay huwag magkalat ng sakit o umabot sa May mga nanay na inuuna pa ang na kaya daw ayaw nilang magpabakuna kasi pagbubuwis ng buhay sa mga susunod na magbingo o mag-tong-its kaysa pumunta sa ang susungit ng mga tao sa health center, araw. health center. Minsan nga nandoon na ako simula sa mga community/barangay health Gaya naman ng dati, dadami sa bahay nila ayaw pang tumayo sa tong- worker, health center staff, kahit nga ng mga ang kaso ng tigdas, maraming mahahawa, its kasi hits na daw siya. Alangan naman aid. Kapag 'yun na ang katuwiran ng nanay, may ilang mamamatay, at ano ulit? Sa hintayin ko pa siyang manalo sa game bago hindi ko na ito madepensahan kasi nga totoo amin na namang mga health workers ang ko bakunahan ang anak niya. Sobra na din naman. Kaya nga noong nagtrabaho ako sisi – “Yung mga taga health center kasi namang serbisyo publiko 'yun. sa isang health center ng isang LGU, may rule ang tatamad!” At pagkatapos, saka lang May mga nanay na laging sinasabi kami doon na “bawal magalit” at “bawal ang na naman maalarma ang mga nanay, saka na may lagnat 'yung anak nila. Kapag nakasimangot." lang sila tatayo sa pagto-tong-its at hindi tinanong mo kung ilang ang temperature Pero kahit ganoon pa man, muna magbibingo para pumila sa health ng bata, hindi alam. Sasabihin nalang sa ’yo, napakarami pa ring health center staff na center at magpabakuna. Doon lang nila “Basta mainit po Ma'am.” Gusto ko na ngang nagsasakripisyo mag-house-to-house para sasabihin sa iyo, “Ma’am hindi po ninyo kasi sagutin ng, “Pag malamig ho 'yang anak lang magbakuna, kahit na sa ilalim ng nabakunahan yung anak ko!"

March - April 2014 I HEALTHbeat 49 SAbeat Purely Mental Tibay ng Dibdib Sinungaling

MIKE: Alam n'yo po Itay, ang babaeng ERNIE: Pare, hiniwalayan ko na ang pakakasalan ko ay katulad ni Inay. syota kong sinungaling. Sabi AMADO: Anak, tibayan mo lang ang dibdib niya kasi doon siya natulog sa mo, kakayanin mo din 'yan! ate niya kagabi. FRANK: Oh, anong problema dun? Awang Awa ERNIE: Ako kaya ang katabi ng ate niya kagabi. LENI: Bakit kulang ng P1,000 ang sweldo mo? Hiwalay JOEREM: Pasensya ka na, Honey. Nag- beerhouse ako. Ang P200 ay FRED: Maghiwalay na tayo. Alam ko binayad ko sa beer. Ang P800, naman kakayanin mo. binigay ko sa dancer kasi walang See No Evil JOYCE: Kaya kong mabuhay nang wala damit. Awang awa ako. ka. Hindi ka naman pagkain o Nag-costume si Misis para takutin tubig, noh? 'Wag kang assuming! Surprise ang asawang lasing... JOJO: Shino ka?!? Tigilan Na Kasi CLERK: Ma'am, bibili po ba kayo ng baril? ROSE: Ako si Satanas! Kukunin na kita! JEAN: Oo, para sa asawa ko. JOJO: 'Wag mo ko takutin #@%&! FRANCIS: Pare, tigilan mo na kasi ang CLERK: Napaka-personal po ng baril. Ashawa ko kapatid mo! pag-inom ng alak. Hindi 'yan Kailangang babagay ang baril ang solusyon sa problema! sa magme-may-ari nito. Isama Selfie NELSON: Kung iinom ba ako ng gatas, ninyo si Mister para makapili mawawala ba ang problema ko? siya ng bagay sa kanya. RUBEN: Pare, napapansin ko na lagi JEAN: Hindi kasi pwede, masisira ang mong kinakausap ang sarili mo. Ayaw na Ayaw surprise ko. Hindi nga niya alam Hindi kaya nababaliw ka na? na balak kong barilin siya. GED: Hindi naman siguro, Pre. Hindi ko PAKING: Alam mo, ayaw na ayaw kong naman sinasagot eh. makakita ng nakatayong babae Katapusan ng Mundo sa bus habang ako eh nakaupo! Suicide BORGY: Kaya pinapa-upo mo? OSCAR: Hay naku, dear! Malapit na pala PAKING: Hindi! Pumikit ako at natulog! ang katapusan ng mundo! ERIC: Dok, magpapakamatay nalang DELIA: Heh! Ang problemahin mo ay ako. Tatalon ako sa 4th Floor! Baliw na Gulay ang katapusan ng buwan at DOK: Paano yan? Eh, hanggang 2nd marami tayong bayarin! Mas floor lang ang building na ito? ERMA: Ano ang gulay na baliw? matakot ka sa maniningil ERIC: Puwes, tatalon ako sa 2nd floor LITA: Meron bang ganu’n? Ano? kapag hindi tayo makabayad! ng dalawang beses! ERMA: Okra! Nag­lalaway mag-isa!

50 HEALTHbeat I March - April 2014