HEALTH exam HULAAN mo nalang

_____ 1. Which of the following health issues do you think is Healthbeat’s Top Health News in 2010... a) Dengue b) HIV/AIDS c) Reproductive Health

_____ 2. In the Health Calendar of Events, Garantisadong Pambata (GP, a child health campaign) is highlighted every... a) April and October b) January and June c) May and December

_____ 3. There are more internet users in... a) Asia b) Europe c) North America

_____ 4. The kind of fat present in crackers, cookies, cakes, doughnuts and french french fries is called... a) saturated fat b) trans fat c) unsaturated fat

_____ 5. The skin allergy test that involves the placement of various chemicals into small metal cups affixed to paper tape and then placed onto the skin of the back is called... a) Intradermal Test b) Patch Test c) Scratch Test

_____ 6. The leading cancer site accounting for 15% of all cancers in the Philippines is... a) Breast Cancer b) Liver Cancer c) Lung Cancer

_____ 7. Republic Act 9211 or the Tobacco Regulation Act of 2003 mandates absolute smoking ban in... a) Bars b) Restaurants c) Schools

_____ 8. The US Centers for Disease Control says that the proper way to cover the nose and mouth when you cough and sneeze is by using: a) both hands b) handkerchief c) shirt sleeve

_____ 9. A condition where there is involuntary tightness of the vagina during attempted intercourse is called... a) Chlamydia b) Dyspareunia c) Vaginismus

_____ 10. The publicly-outed HIV positive writer who wrote the screenplay (script) of the first Department of Health’s co-produced indie (independent) film entitled “HIV - Si Heidi, Si Ivy at si V” is... a) Wanggo Gallaga b) Ricky Lee c) Jake Tordesillas

Answers on Page 49

November - December 2010 I HEALTHbeat 3 DEPARTMENT OF HEALTH - National Center for Health Promotion 2F Bldg. 18, San Lazaro Compound, Sta. Cruz, Manila 1003, Philippines HEALTHbeat Tel. No. (63-2) 743-8440 Email: [email protected] Health is Everywhere

The events in 2010 prove that health is everywhere. From the smoking habit of the newly- elected President in Malacañang to the several legal suits against the implementation of the Adminstrative Order requiring graphic health information and removing misleading descriptors in cigarette packs filed in several regional trial courts. From the nasty rumor of “vaginal captivus” of a young couple in the entertainment industry to Dr. Vicky Belo’s advertisment promoting medical tourism in immigration cards at international airports.

A newborn baby is left alive in an international plane’s toilet and dead fetuses are found in garbage dumps, church yards, creeks, Manila Bay and elsewhere. Debates over the resurrected reproductive health bill reverberated in both Houses of Congress and in the Editorial Board sanctity of Catholic churches. High risk behaviors for HIV/AIDS allegedly are high among young Asuncion M. Anden, MD, MPH, CESO II professionals in call centers according to a study, and dengue cases have risen into an all-time Ivanhoe C. Escartin, MD Rosemarie G. Aguirre high affecting mostly children including the Presidential nephews according to official data.

Editors-in Chief Anthony R. Roda A string of bus accidents occurred over a three-month period and a tourist bus hostage crisis May Elenor R. de Guzman brought shame to the country and the newly-installed government which at that time had not passed its 100 days of office yet. And the very limited health human resources in the country Managing Editor Donato Dennis B. Magat experienced a big blow with the rape of a volunteer nurse in South Upi, Maguindanao and the Staff Writer Elizabeth G. Mascareñas allegation of communist activities of 43 health workers in Morong, Rizal. Cover Design Diosdado P. Angeles, Jr.

And speaking of health human resources, this is the year when the Department of Health had Photographer Paquito P. Repelente three secretaries – from the 15 remaining days of Dr. Francisco T. Duque III before he became the chairman of the Civil Service Commission to the five and a half months’ term of Dr. Esperanza I. Contributors (Words) Benjamin P. Reyes, DMD, MPH, MDM Cabral, and to the going on six months in office and counting of Dr. Enrique T. Ona. Tato S. Usman, MD, MPAIM

Health is wealth, and we just hope that this fact will be reflected in the DOH budget increases (Pictures) Rowena N. Bunoan Paulo Rafael C. Caguioa in the coming years in order for us to achieve President Noynoy Aquino’s promise of universal Joerem P. Ceria health care within three years. But with or without a reasonable health budget, we still have to Vina Marie Cotin work our best in the most able manner that we can provide as we have always done in the past, Dr. Maricar Limpin Engr. Rene Timbang and always making us one of the top performing government agencies. (Illustration) Paul Ritz Magtrayo No need to be stressed out, health workers! Relax, see the HIV movie –“Si Heidi, Si Ivy at si V.” Circulation DOH-NCHP Production, Dissemination - The Editors and Collection Section

FOR EDUCATIONAL PURPOSE 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 November - December 2010 contents

Healthier Food Choices Good For You 6 Basta Kalusugan ng Bata, i-GP Mo! 11 Log on to Internet Addiction 14 6 Take Your Breath Away 18 Piloting the Patient Navigation Program 22 HIV - “Si Heidi, Si Ivy at si V” 25 Vaginal Lock: Is it Real and Is it Rare? 30 Weighty Problem 33 How Do You Cough and Sneeze? 34 When Allergy Gets in the Way of Vanity 35 Health News: Top 10 in 2010 39 22 39 Bad “Locked” 39 Justice for “Florence” 40 Free Morong 43 41 Rolling Coffins 42 No Approved Therapeutic Claim 43 Universal Health Care 44 Go and Multiply Debates 45 Pakita ang Totoo sa Pakete 46 Rising HIV/AIDS 47 Living Dengue-rously 25 35 JOKES N’YO 16 TIDbeat 47 17 KALAbeat 38 laughter HEALS 50 SAbeat HEALTHY eating Healthier Food Choices GOOD FOR YOU Very soon, you will see healthy Alimentarius as well as the standards set for meant to change what food manufacturers food products in supermarkets and healthy the European Union and the US Food and and food service establishments are already dishes in food establishments which are low Drug Administration. These guidelines also providing the public. Rather, it is intended in fat, low in sodium, low in sugar and high follow the standards of the DOH Food and to encourage food manufacturers and food in dietary fiber that are GOOD FOR YOU. Drug Administration (FDA). service establishments to produce products The World Health Organization On the other hand, the main and offer dishes that are healthy so that (WHO), through the Department of Health purpose of the Good For You certification consumers are given an opportunity to (DOH), commissioned the Nutritionist- program is to provide consumers with an choose what is good for their health. Dietitian’s Association of the Philippines easy way of identifying which products or Both the Guidelines on Healthy which has established the “Guidelines for dishes are healthy and to convey to them Eating and the Good For You certification Healthy Eating” and developed a certification that they have the option of choosing a program adhere to the World Health program for healthy food products healthy alternative from among the products Organization (WHO) Global Strategy “Healthy eating” is anchored normally produced or sold in the market on Diet, Physical Activity and Health on principles of adequacy, balance, and and dishes which are served in restaurants. which emphasizes the need to limit the moderation of food intake. It is also A Good For You stamp (see figure below) consumption of saturated fats and trans characterized by regulating the intake will appear on food labels or menu cards fatty acids, salt and sugars, and to increase of foods high in fat, sodium and sugar of certified products and dishes which will consumption of fruit and vegetables and that are directly linked with the onset of aid consumers to easily identify food items levels of physical activity. It also addresses noncommunicable diseases (NCDs) and that are considered healthy based on the the role of prevention in health services; increasing the intake of foods with dietary guidelines. food and agriculture policies; fiscal policies; fiber that helps prevent or delay the onset of The certification program is not surveillance systems; regulatory policies; NCDs among at-risk individuals. consumer education and communication The four major NCDs related including marketing, health claims and to poor eating habits are heart disease, nutrition labelling; and school policies as stroke, diabetes and cancer. Meanwhile, they affect food and physical activity the risk factors for NCDs that have choices. been linked with unhealthy diet include hypertension (high blood Guidelines on Fat pressure), hyperglycemia (high blood sugar), Fats and oils are part of hypercholesterolemia (high a healthy diet and are major cholesterol levels in the sources of energy and aid the blood) and obesity. body in absorbing vitamins, In general, the b u t the type of fat makes a difference “Guidelines on Healthy Eating” to heart health, and the total are aligned with international amount of fat consumed is also standards set by the Codex important.

6 HEALTHbeat I November - December 2010 Not all fats are the same. Saturated and trans fats increase the risk of heart disease by increasing the total and LDL (“bad”) cholesterol. Dietary cholesterol, on the other hand, is not technically a fat, but it is found in food derived from animal sources. Intake of dietary cholesterol increases blood cholesterol levels, but not as much as saturated and trans fats do, and not to the same degree in all people. Saturated fats come from animal products (such as meat, poultry, seafood, eggs, dairy products, lard and butter), and FAT. Photo grabbed from coconut, palm and other tropical oils. Trans fat comes from partially hydrogenated the sum of saturated fatty acids and trans-fat when cooking or better still use oven-baked vegetable oils, commercial baked goods must be less than or equal to 10% of energy chips. (such as crackers, cookies and cakes), from fat. 5. Make sure the oil used for frying fried foods (such as doughnuts and french 6. For a product to be considered is at the correct temperature since this fries), shortening and margarine. Dietary as cholesterol-free, it should contain an reduces the amount of fat absorbed by the cholesterol are from animal products (such as amount less than or equal to .005 g per 100 food. meat, poultry, seafood, eggs, dairy products, g solids or 100 ml if liquid. 6. Drain/blot fried foods for excess lard and butter). 7. For a product to be considered oil before serving when possible. The recommended guidelines for as low in cholesterol, it should contain 7. Offer frozen yoghurts or sherbets fat are: an amount equal to or less than .02 g per as an alternative to ice cream for lesser fat 100 g and .01 g per 100 ml liquid with the intake. For Food Manufacturers assumption that saturated fatty acid (SFA) is 8. Use reduced-calorie mayonnaise 1. For a product to be considered as less than or equal to 1.5 g per 100 ml solid in dressings or dilute with yogurt that is healthy, it should contain less than 5 g per and 0.75 g per 100ml liquid. The amount of lower in fat. 100 g of total fat. SFA should also be less than or equal to 10% 9. Remove visible fat from meat 2. For a product to be considered of energy from SFA. and skin from poultry. as fat-free, it should contain an amount less 10. Use mono- and poly- than or equal to 0.5 g per 100 g solid or 100 For Food Service Establishments unsaturated fats wherever possible for ml liquid. 1. When selecting and preparing cooking, spreads and in dressings. 3. For a product to be considered as meat, poultry, dry beans, and milk or milk low-fat, it should contain an amount equal products, make choices that are lean, low Guidelines on Sodium to or less than 3 g per 100 g solid and 1.5 g fat, or fat free. per 100 ml liquid. 2. Try to cut down on the amount Sodium is a mineral that occurs 4. For a product to be considered of fried foods offered, such as chips and other naturally in varying amounts in fresh as saturated fat-free, it should contain reconstituted potato dishes. and processed foods. Some of the major an amount less than or equal to 0.1 g/100 g 3. Use skimmed or semi-skimmed functions of sodium in the body is for proper solid or 100 ml liquid. milk rather than butter or margarine to mash fluid balance –control of the movement of 5. For a product to be considered potatoes. fluids in and out of the cells; regulate blood as low in saturated fats, it should contain 4. Choose thickly cut chips or pressure, transmit nerve impulses and help in less than or equal to 1.5 g per 100 ml solids potatoes wedges instead of thinly cut chips, muscle relaxation. The link between sodium and 0.75 g per 100 ml liquid provided that when possible because they absorb less oil and hypertension or high-blood pressure is

November - December 2010 I HEALTHbeat 7 well documented. High blood pressure is a 480 mg sodium per Reference Amount amounts of sodium than fresh produce. major risk factor for coronary heart disease Customarily Consumed (RACC). For example, 3. Use herbs and spices, or infused and stroke. bread – RACC: 50 g, therefore, sodium must vinegar to add flavor to entrees. The current intake of sodium not exceed 480 mg. 4. Use unsalted butter when among Filipinos is about 2.8 to 6.0 grams 2. For a product to be considered to necessary. from an average salt intake of 7-15 grams, have very low sodium, it should contain less based on the 2003 Food and Nutrition than or equal to .04 g sodium per 100 g solid Guidelines on Sugar Research Institute National Nutrition Survey. or 100 ml liquid. However, the sodium intake of Filipinos is 3. For a product to be considered Sugar as a carbohydrate, is an probably higher than this particularly from as low sodium, it must contain only sodium indispensable source of energy, but when processed foods including instant noodles. levels of less than 0.12 g per 100 g. taken in excessive amounts, it can have The recommended guidelines for negative effects on the health of individuals. sodium are. For Food Service Establishments However, individuals tend to consume more 1. Use products that have met the processed food items which usually have For Food Manufacturers guidelines for healthy eating for sodium. added sugars in order to enhance taste. 1. For a product to be considered 2. Use fresh ingredients if possible Studies on the influence of sugar as healthy, it must not contain more than because processed foods contain higher in the development of NCDs have shown varied and sometimes conflicting results. However, several studies have shown that an increase in the consumption of added sugars increases overall carbohydrate and calorie intake, more so when the added sugar is in a beverage. This, in turn, increases the risk of serious health concerns specifically, obesity and all its related diseases, such as Type 2 Diabetes Mellitus and cardiovascular diseases. The recommended guidelines for sugar are:

For Food Manufacturers 1. For a product to be considered as healthy, its total sugar content should be less than 5.0 g per 100 g serving. 2. For a solid product to be considered as low in sugar, it should not contain more than 0.5 g per serving. 3. For a liquid product to be considered as low in sugar, it should not contain more than 0.5 mg per 100 ml of the liquid.

For Food Service Establishments Top: SODIUM IN SALT. Photo grabbed from . Bottom: SUGAR. Photo grabbed from 1. Use products that have met the . guidelines for healthy eating for sugar.

8 HEALTHbeat I November - December 2010 2. Reduce the amount of sugar and savory dishes. in a fast food outlet, or in the facades or used in dishes and drinks where practical 5. Portion size counts; visualize signage of the supermarket, market and fast and acceptable. serving portions. food establishment. 3. Offer fresh fruit juices without If a product wants to put a health added sugars. GOOD FOR YOU Certification Program claim on the label regarding either fat, sugar, sodium and fiber, it must meet the Guidelines on Dietary Fiber Based on the Guidelines on basic criteria, which are based on the cut- Healthy Eating, the Good For You certification off prescribed by the Codex Alimentarius or Fiber is a substance in plants. It is program is established which aims to a collection of internationally recognized in fruits, vegetables and grains. It is the part contribute to the attainment of a healthy standards, codes of practice, guidelines and of the plant that your body cannot digest. Filipino population through good nutrition. other recommendations relating to foods, Yet it is an important part of a healthy diet. It specifically aims to help consumers food production and food safety. (See Table It adds bulk to the diet and makes a person make healthy food and eating choices 1 next page.) feel full faster, helping control weight gain. consistent with the recommendations of In addition to the health claim Fiber helps digestion and helps prevent the WHO Global Strategy on Diet, Physical applied for by processed products, other constipation. Activity, and Health as well as to help the nutrients must not exceed the normal Evidence shows consistently that agriculture sector, food establishments and levels of that nutrient per day. (See Table 2 diets high in plant foods are associated with manufacturers in developing products that next page.) For example, if a product wants a lower occurrence of some chronic diseases respond to consumer need for healthy food to claim “low cholesterol”, it must meet such as coronary heart disease, diabetes, options. the criteria for low cholesterol and at the and cancers of the lung, colon, esophagus The program covers processed same time, its values for sodium, fat and and stomach. foods as well as menu items in fast food sugar must not exceed the normal values The recommended guidelines for outlets and restaurants. It does NOT cover recommended per day. dietary fiber are: carbonated beverages, juice drinks, alcoholic Other considerations in certifying beverages, infant formula, all kinds of milk, food products and menu items include: For Food Manufacturers complementary food, and extruded snack products must be registered with DOH- 1. For a product to be considered as foods. FDA, while fast food establishments must a source of fiber, it should contain an amount The program will involve the be registered either with the Securities and of 3 g per 100 g or 1.5 g per 100 kcal. conferment of the “Good For You” stamp for Exchange Commission or the Department of 2. For a product to be considered as use in food labels, market or supermarket Trade and Industry; processed foods should high in fiber, it should contain an amount of markers, menu marquees, designated area be classified as having been produced under 6 g per 100 g solids or 3 g per kcal.

For Food Service Establishments 1. Use products that have met the guidelines for healthy eating for dietary fiber. 2. Offer whole grain cereals and root crops such as brown rice. 3. Offer colorful and interesting salads (with low-fat dressings) and vegetables with main meals. 4. Try to offer alternative fruit dishes, and incorporate fruit into other desserts and dishes, including cold starters DIETARY FIBER. Photo grabbed from

November - December 2010 I HEALTHbeat 9 Table 1. Basic Criteria for Qualification to the Good-for-You Seal Php 1,000 per product, which covers 3 years of registration. The documents required DESCRIPTOR CRITERIA are: FDA registration; label; five samples of Low-calorie or low-energy ≤40 kcal/100 grams solid or product; laboratory analysis of contents from ≤20 kcal/100 ml liquid FDA-accredited laboratories. Step 3: Review of application by Low fat ≤3 grams/100 g solids, or the Good For You Certifying Committee for a ≤1.5 g/100 ml liquid minimum of one month. Less than 3 g of trans fats/serving Step 4: Results will be emailed Low saturated fats ≤1.5 g per 100 g solid, together with a list of consequent steps that or 0.75 g per 100 ml liquid, and should be followed prior to inclusion of the contributes ≤10% of calorie content stamp in the label of the product. Less than 3 g of trans fats/serving If application is APPROVED, manual

Low cholesterol ≤0.02 g per 100 g solids, or on the use of the Good For You stamp will be ≤0.01 g per 100 ml liquids sent via email to the manufacturers so that a Less than 3 g of trans fats/serving sample label with the stamp can be prepared and submitted to the FDA for approval. Once Low sugar ≤0.5 g per 100 g solids, or the label is FDA-approved, a representative ≤0.5 g per 100 ml liquids of the manufacturer should submit a sample Low sodium ≤0.12 g per 100 g of the approved label to the NDAP office Source of dietary fiber ≥3 g per 100 g or ≥1.5 g per 100 kcal. before mass production of the label for filing. The representative will also be given the Table 2. Normal Level of Nutrient Per Day. official Good For You Certificate of Approval. Approved products would automatically be NUTRIENT NORMAL LEVEL/DAY included in the Good For You website and Fat 40 - 60 g/d the products will be monitored for three Cholesterol <300 mg/d years. After that period, products would be Sodium 2400 mg/d required to renew their certification. Added Sugar 40 g/d If application is DENIED, a Fiber 25-30 g/d notification email will be sent to the manufacturer, and the manufacturer or good manufacturing processes regardless The steps in the Good For You representative will be advised to visit the of criteria for certification being applied certification are: NDAP office to discuss the reasons for for; and points of sales of products or menu Step 1: Visit the NDAP website disapproval. Re-application is possible items to be certified should conform with the at www.ndap.org.ph to download the once the reasons for disapproval are duly requirements for food safety as indicated by application form and to schedule an addressed by the manufacturer. the presence of an approved business permit application date. Manufacturers should Only products or places approved from the local government unit. wait for a confirmation email regarding the to show the stamp may do so. The use of the The certification program will be schedule of their application. stamp without the approval of the certifying managed by NDAP which will create a “Good- Step 2: Submit to the NDAP group shall be considered as mislabelling or for-You Certifying Committee” composed of Office on the scheduled application date misrepresentation and shall be subjected two to three selected NDAP members and a the application form with documentary to the appropriate administrative and legal representative of the DOH. requirements, pay the application fee of sanctions. If we eat what is good for our bodies, then our bodies will be good to us.

10 HEALTHbeat I November - December 2010 child HEALTH Basta Kalusugan ng Bata, i-GP mo! There’s something new in the convey is that the provision of child health is delivery of Garantisadong Pambata (GP) not only limited to going to the health centers health services in the country – from focusing for free and effective services. The care for the only on child survival interventions of child is every day, at home, school, health preschoolers (0-5 years old), it has expanded facility, and by different partners. Moreover, in providing services and information on the household is the key provider of health health, nutrition, and environment for care and not only the responsibility of the newborns up to 14 year-old children. health facility and community. GP, as it is popularly known in the Health Secretary Enrique T. health sector, is an institutionalized national Ona said, “The new GP will highlight health campaign conducted every day health-promoting behaviors that parents, with special event every April and October caregivers, teachers, leaders and children where essential package of health services themselves can do in their respective spheres and health information are delivered to of influence.” protect 0-5 years old children and promote With a rallying call “Basta i-GP positive behaviors to parents and caregivers. mo!”, the DOH aims to make GP synonymous This essential health package includes the The new GP logo. with healthy behaviors and practices. “When promotion of exclusive breastfeeding for six we say i-GP mo, we mean healthy behaviors months, providing routine immunization child health services in health facilities, that anyone can do to protect child health. among infants, giving vitamin A supplement the new GP now involves non-traditional Essentially, this translates to giving children and de-worming tablet every 6 months, community outlets like day care centers, their right to universal access to quality education on proper handwashing with schools, and workplaces. The Department of health care, services and information,” Ona soap and water, brushing of teeth regularly, Health, other national government agencies, said. using the toilet properly, and keeping homes local government units, international and tobacco smoke-free. national development partners and the Php 2 Billion for GP For the new GP, 6-14 years old private sector will be the implementers. children were included in the coverage. For the new GP, DoH will work The DOH is allotting at least two billion pesos Services will be diversified to fit the life with the Department of Social Welfare from its 2011 budget for its expanded child stage segments of 0-14 years. By expanding and Development (DSWD), Department of health program. The GP budget will include the coverage of GP to include school-aged Education (DepEd), Department of Interior purchase and distribution of essential children, the Department of Health is and Local Government (DILG), and other vaccines, micronutrient supplements, de- recognizing that when a child reaches six development agencies like the US Agency worming tablets, and health promotion. This years old, he or she moves to the realm of for International Development (USAID), UN 2011 allocation for child health is a five-fold school and learning, and health and nutrition Children’s Fund (UNICEF), and World Health increase from the PhP 325 million budget in continue to play a crucial role in a child’s Organization (WHO). 2010. development. Moreover, instead of confining The messages the new GP want to In addition to the budget increase,

November - December 2010 I HEALTHbeat 11 Ona also said that the DOH and the DSWD coverage of basic health and nutrition Child Health Today are working on an alignment of resources services especially among the poor and to ensure that poor families who receive vulnerable children. This is in consonance The 2008 National Demographic conditional cash transfer grants will receive with the call of President Benigno Simeon Health Survey (NDHS) data show that the appropriate services from health Aquino III to increase private participation childhood morbidity and mortality has been providers. and consolidate efforts and governance decreasing in the past decade. Pneumonia, DSWD Secretary Corazon Juliano operations. GP will take a new direction measles, diarrhea and deaths due to neonatal “Dinky” Soliman said that the DSWD has starting this month of October. complications remain among the top leading taken a more active role not just in ensuring Referring to partnerships between causes of under-five mortality. Malnutrition the welfare and promoting the rights of the public and private sectors set to represent remains the major risk among children. disadvantaged children, but also in providing a cornerstone of this Administration’s Children aged 6-23 months who them their health and nutrition needs. modernization programme, Ona said. live in rural areas and whose mothers are in She stressed that the Pantawid Pamilyang “It is hoped that we can deliver better the poorest quintile are more likely to show Pilipino Program (4Ps), the country’s poverty quality public services by bringing in new symptoms of acute respiratory infection. reduction program, and supplementing investment and improved management, Child injuries contribute significantly to feeding program for day care children and help government agencies like the deaths in the older age group. Under nutrition contribute to the objectives of GP. DOH achieve their full potential in ensuring remains a challenge in the Philippines. Ona also invited other organizations quality health services for all,” he added. The prevalence of breastfeeding in the and the private sector to be part of the GP A key challenge to the DOH is how country has declined. The median duration movement. “We hope to showcase the GP to transform its resources into higher value of exclusive breastfeeding is less than one as a concrete example of public and private goods and services. Competition by the month, while the duration of predominant partnerships in good governance,” he said. different stakeholders should be avoided breastfeeding is 2.7 months. and partners should re-align their plans Based on the 2008 National Private and Public Partnership to the universal health care policy on child Nutrition Survey by the Food and Nutrition health, nutrition and environment and the Research Institute of the Department Ona said that GP is an approach to promotion of positive behavior and values of Science and Technology, in every 100 promote equity and rapidly achieve universal for viable and profitable projects. preschool children (0-5 years), 26 were underweight, about 28 were Panatang Maka-GP under height and 6 were thin. At the other end of malnutrition, Sa bawat araw na dadaan in every 100 of these children Iisipin ko ang aking kalusugan were 2 overweight for their Kamay ay huhugasan age and 3 were overweight for bago kumain at matapos madumihan their height. Meanwhile, for Pipillin ko rin ng husto schoolchildren aged 6-10 years pagkain masustansya at wasto old, in every 100 children about Ngipin ay sisipilyuhin 26 were underweight and 2 were Pagligo ay aaraw-arawin overweight. And about 32 in Gagamitin ko ang palikuran every 100 of these children were Sa tama at malinis na paraan under height. Mga kuko ay laging gugupitin Also based on the Tsinalas at sapatos laging susuutin survey, Vitamin A deficiency also continues to be of public Sa garantisadong mga paraan health significance, with 15.2% Aking kalusugan ay aalagaan. prevalence rate among children.

12 HEALTHbeat I November - December 2010 TOP: GP streamer. ABOVE: Dr. Eduardo Janairo, director of the DOH National Center for Disease Prevention and Control (at the podium) explains the new GP. RIGHT: Health Secretary Enrique T. Ona with child celebrity BJ Forbes, the Junior Bright Child Ambassador of Goodwill. (Photos by Paking Repelente)

Meanwhile, a follow-up study The GP started in 1999 to address diseases and infections like measles, tetanus, on the prevalence of soil-transmitted low coverage rates on immunization and polio, hepatitis and tuberculosis. About 80 helminthiasis (STH) or parasitic worms micro-nutrient supplementation. Since per cent of children below five years old conducted by National Institute of Health of then, the GP has become a pivotal campaign received vitamin A supplements twice a year the University of the Philippines in 2009, the for the DOH and local governments to to boost children’s resistance. results showed a decrease in the rate among encourage caregivers to focus on critical Moreover, the GP program targets preschool children from the baseline rate of health interventions for young children. 100% of children aged 1-5 years old and 66.44% in 2004 to 22.74% in 2009. Among The National Statistics Office in its those aged 6-12 years enrolled in public schoolchildren 6-12 years old, the rate also 2008 survey reported that four out of five elementary schools to receive deworming decreased from a baseline of 54% in 2006 to children below two years old received all tablets every six months to reduce prevalence 44.7% in 2009. the required vaccines to protect them from of parasitism in these age groups. It takes a tribe to raise a child.

November - December 2010 I HEALTHbeat 13 internet ADDICTION

log on to Internet ADDICTION by BENJAMIN P. REYES, DMD, MPH, MDM National Center for Health Promotion

No doubt, internet has revolu- INTERNET USERS DISTRIBUTED BY WORLD REGION, 2010 tionized the way people work, play, study, communicate and share information. Each day we become more dependent on the growing volume of information that can be shared on the world wide web. According to the June 2010 report of the Internet World Statistics, conducted by the Miniwatts Marketing Group, there are around 1,966,514,816 internet users worldwide. This is a 444.8% growth rate from the year 2000, ten years ago. Surprisingly, Asia has the biggest share of users among world regions. But how much is too much internet In the June 2010 Report of the Internet World Statistics, conducted by the Miniwatts Marketing Group, use? Are we getting more comfortable with there are around 1,966,514,816 internet users worldwide. Surprisingly, Asia has the biggest share of making online friends than with real people? users among world regions.

14 HEALTHbeat I November - December 2010 Do you compulsively surf for hours without The University of Texas at Dallas friends. Internet becomes a more convenient any real need for it? Do you play games or (UTD) mentioned that anyone who uses option. gamble until the wee hours of the morning? a computer could become vulnerable to UTD also identified experiences These and other signs maybe indicative that internet/computer addiction. Apparently that may be indicative that a person maybe you may already have an internet “problem.” more vulnerable to computer abuse are the having a problem or is already an internet/ people who are lonely, shy, easily bored, or computer addict. These include: having mixed When Internet Use is a Problem suffer from another addiction or impulse feelings of well-being and guilt while at the control disorders. computer; making unsuccessful efforts to It is difficult to determine when Here are some risks factors quit or limit your computer use; losing track internet use is a problem simply because each identified which may lead to addiction: of time while on the computer; neglecting person requires varying degrees of internet • Persons suffering from anxiety. friends, family and/or responsibilities in use. Constantly keeping in touch with loved Internet is often used to distract oneself from order to be online; lying to the boss and ones who are working or staying in other worries and fears. Obsessive-compulsive family about the amount of time spent on countries may require late night vigils in the disorders and other anxiety disorders may the computer and what you do while on it; net. Doing research or work in the net may also contribute to excessive email checking and developing problems in school or on the also take extensive on-line hours. So staying and compulsive Internet use. job as a result of the time spent and the type for several hours surfing the net is really • Depressed persons. The Internet of activities accessed on the computer. . not the issue. It only becomes a problem provides much entertainment and can be an Other experiences of being a when it already interferes with the person’s escape from feelings of depression, but too internet/computer addict are: feeling normal daily activities, responsibilities and much time online can make things worse. anxious, depressed, or irritable when relationships. People usually get hooked on Internet addiction further contributes to computer time is shortened or interrupted; the Internet because of three reasons; social isolation and loneliness. repeated computer use as an outlet when networking, gaming and internet porn. • Other forms of addictions. sad, upset, or for sexual gratification; and Although there have been no Many Internet addicts suffer from other when not on the computer, the person thinks formal recognition of the concept of addictions, mainly to drugs, tobacco, alcohol, about it frequently and anticipate when he/ compulsive internet use as a psychological gambling, and sex. she will use it again. disorder, we often hear anecdotal reports of • Lack of social support. Internet The common physical signs can also such behaviors which practically mimic the addicts often use chat rooms, instant be attributable to the problem. Computer same pattern as those under the influence messaging, or online gaming as a safe way addicts often experience one or more of of other addictive substances. Hence, some of establishing new relationships and more the following; carpal tunnel syndrome or have come to call this rising phenomena as confidently relating to others. pain, numbness, and burning in your hands “Internet/computer addiction”. More often • Being a teenager. Just like in that can radiate up the wrists, elbows, and than not, these individuals spend most of other forms of addiction, adolescents and shoulders; dry eyes or strained vision; back their time online to the detriment of their teen-agers are vulnerable because the and neck pains; severe headaches; and sleep personal lives and health. Some lose track brain areas, critical for assessing situations, disturbances. of time while playing online games. Others making sound decisions, and keeping our fail in their responsibilities to study and emotions and desires under control are still Escaping Internet Addiction work because of too much time spent on developing. At the same time, at a stage of the net. Personal hygiene and health is also finding oneself, internet might give more Compulsive behaviors like internet disregarded by some, just to stay “connected”. comfort than real life friends. addiction can be hard to break. Addictive Virtual sexual stimulation becomes more • Less mobility or less social behaviors are neither a matter of will nor desirable than stimulation from actual life activity. Persons coping with a new a factor of a person’s resolve to get better. partner. Some go even further by stealing disability that limits ability to drive or more More often than not, the more support one money, or using money for tuition just to pay and parenting very young children can make gets during the process of cutting down, for their stay at the internet cafes. it hard to leave the house or connect with old the more successful the person will be. It

November - December 2010 I HEALTHbeat 15 is therefore critical that family members for needed skill enhancement, such as your concerns with their computer use. and peers understand the role they play in problem solving, assertiveness, social skills, Being a good role model can help helping a loved one get rid of the problem. overcoming shyness, and anger control can them adjust and remove the problem. By As with other addictive problems, treatment stimulate interaction in the real world. managing one’s own personal computer begins with recognizing that there is a • Assessing and addressing other use, a parent or friend could demonstrate problem. disorders like depression or anxiety that how to employ the media in a responsible Overcoming denial should be may need medical treatment may increase and proper way. Similarly, introduce them followed by other steps which includes: changes of overcoming addiction. to people who also handle their computer • Agreeing on a behavior • Providing easy access to utilization sensibly. Better yet, involve them modification plan. Establishing controls that assistance by locating or forming a support in non-computer related activities, like will limit the time spent on the net, such as group for others who are trying to regain outdoor sports and other similar interests. setting a timer for usage, planning a daily control over their computer use can likewise If and when they agree on the schedule, keeping a log of moods when improve success rates. problem, support their desire for change. going online, matching time spent online A better understanding on why Seeking professional help, when deemed with time spent socializing face to face the person used the internet or the computer necessary should always be an option, and taking part in non-computer related as a coping tool should be pursued. If a child to provide comprehensive care for the activities, and enforcing them can help. or a friend is addicted to the internet or individual. • Focusing on other areas computer use, feel free to talk to them about - o O o - TIDbeat Battle of the Sexes

A teacher was explaining to her 3. Even the class that in Spanish, unlike English, nouns are smallest mistakes are stored designated as either masculine or feminine. in long term memory for “House” for instance, is feminine: “la possible later retrieval; and casa.” “Pencil,” however, is masculine: “el lapiz.” A 4. As soon as you student asked, “What gender is the computer?’” make a commitment to one, Instead of giving the answer, the you find yourself spending teacher split the class into two groups, male and half your paycheck on female, and asked them to decide for themselves accessories for it. whether the computer should be a masculine or The women’s a feminine noun. Each group was asked to give group, however, concluded four reasons for its recommendation. that computers should be The men’s group decided that masculine (“el computador”) As soon as this happens... retire with dignity! ‘“computer” should definitely be of the feminine because: gender (“la computadora”) because: 1. In order to do 1. No one but their creator understands anything with them, you have to turn them on; problem; and their internal logic; 2. They have a lot of data but still can’t 4. As soon as you commit to one, you 2. The native language they use think for themselves; realize that if you had waited a little longer, you to communicate with other computers is 3. They are supposed to help you could have gotten a better model. incomprehensible to everyone else; solve problems, but half the time they ARE the Who won? You decide!

(-: Content and photo circulate in the Internet :-)

16 HEALTHbeat I November - December 2010 KALAbeat Muah! Muaahhh!

Muah! Muaahhh! Kiss, Kiss

Dalawang bakla na nakadamit pam- CHICHI: 0ist, Girl! Nabalitaan babae ang nasa kanto ng Buendia at ko nakipag-break ka Taft nang may humintong bus sa harap daw sa boyfriend mo? nila at lumabas ang kunduktor... JOY: 0o, kasi hindi marunong humalik. ‘Tsaka isang KUNDUKTOR: Muah. Muah. style ng kiss lang ang Muaahhh! alam. DENISE: Ang presko naman ng CHICHI: Anong style ‘yun? kunduktor na iyan! JOY: Flying kiss! At gusto pa yata akong sisirin ng halik. Emotional Pain GLENDA: Gagah! Nagtatawag yan ng pasahero Komunsulta si Misis sa isang papuntang Mall of psychiatrist... Asia! DOK: “All emotional pain lasts for 12 minutes and Ang Buhay ay Pelikula Hula anything longer than that is self inflicted.” EMAN: Kung gagawa ako ng pelikula, Nagpahula ang buntis na Misis... ERMA: Pero, Dok, matagal ko nang gusto ko, ako si ZORRO! iniinda ang paghihiwalay namin ELLEN: Eh ako, sino? MADAM ROSA: Sa araw na iluluwal mo ang ng Mister ko. Baliw na ba ako? EMAN: Si DACOS! iyong sanggol, mamamatay DOK: Sa tingin ko, hindi naman. Nag- ELLEN: DACOS? Sino ‘yun! ang ama ng bata. iinarte ka nalang! EMAN: DACOS of all my ZORROs! DIVINE: Hay, salamat at ligtas ang buhay ng asawa ko. Slit ng Palda Mukhang Asar P-Noy Joke • Kapag ang palda ng babae ay may slit LITA: Hudas ka! Lagi kang umuuwing sa likod, ang ibig niyang sabihin ay, lasing. Naaasar na tuloy ako sa SHALANI: Mag-stop ka na ng smoking “Halika, sundan mo ako!” mukha mo. please... • Kapag ang hati ng palda ay nasa gilid, JUN: Pero mahal, kung hindi ako P-NOY: Bakit naman? “Halika, tabihan mo ako.” lasing, ako naman ang SHALANI: Wala lungs! • Kapag ang hati ng palda ay nasa harap, maaasar sa mukha mo! “Halika, pumasok ka!” I kissed my first girl and smoked my first cigarette on the same day. I haven’t had time for tobacco since. ~Arturo Toscanini (-: Jokes and photo from the Internet :-)

November - December 2010 I HEALTHbeat 17 tobacco CONTROL TAKE YOUR BREATH AWAY Measuring Secondhand Smoke Exposure in Public Places

Spending time in restaurants, bars or other entertainment venues where smoking is allowed, even at designated smoking areas only, will take your breath away, LITERALLY! A few minutes’ stay inside in these public places will expose you to high levels of fine particles suspended in the air that can lodge deeply in the lungs and can pose major risks health risks. This is the result of a study measuring secondhand smoke (SHS) exposure in public places in the City of Manila authored by Engr. Rene Timbang and Anthony Roda of the Department of Health

Air nicotine monitors (encircled in the photos) are placed and left for five days in entertainment venues, restaurants, government offices, hospitals and schools to measure secondhand smoke exposure in public places in the City of Manila. (Cellphone photos of Engr. Rene Timbang)

18 HEALTHbeat I November - December 2010 and by Patrick Breysse and Stephen Tamplin of the Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland, USA. The study aimed at measuring the levels of indoor air nicotine and particulate matter

(PM2.5) in public places and establishing baseline levels of SHS exposure to support more progressive smokefree policies. Particulate matter (PM) is the term for particles found in the air, including dust, dirt, soot, liquid droplet and tobacco smoke. Particles can be suspended in the air for long periods of time. Some particles are large or dark enough to be seen as soot or smoke. Others are so small that individually they can only be detected with an electron microscope. RIGHT. The air nicotine monitor is placed in conspicuous areas of an establishment. TOP LEFT. Air Particles less than 10 micrometers nicotine monitor. BOTTOM LEFT. TSI SidePak AM510 Personal Aerosol Monitor that measures PM2.5. The nicotine monitors are left in the establishment for a week and the SidePak is carried by a person in an in diameter (PM10) pose a health concern because they can be inhaled into and establishment for at least 30 minutes, while documenting the smoking behaviors of people inside. accumulate in the respiratory system. Particles less than 2.5 micrometers in Tobacco Survey (2009) revealed that one in the World Health Organization (WHO) daily diameter (PM2.5) are referred to as fine every three Filipinos (33.6%) who visited acceptable level which is 25 micrograms per particles and are believed to pose the a restaurant during the past 30 days was cubic meter (µg/m3). Restaurants also had greatest health risks. Because of their small exposed to secondhand smoke. More than high levels of PM2.5 with more than 4 times size (approximately 1/30th the average one quarter (25.5%) of Filipinos who visited the WHO standard. width of a human hair), fine particles can a government building during the past 30 Republic Act 9211 or the Tobacco lodge deeply into the lungs. Long-term days were exposed to secondhand smoke, Regulation Act of 2003 allows smoking in exposure to PM2.5 can result to respiratory and almost 28 million Filipinos (55.3%) designated areas in public places such as diseases, cardiovascular diseases and lung who used public transportation during the restaurants and entertainment venues. cancer. past 30 days were exposed to secondhand However, evidence shows that separate Cigarrete smoke contains more smoke. smoking sections do not work. Simply than 4,000 known chemical compounds and The Philippine SHS exposure separating smokers and non-smokers within a 2004 study published in the British Medical monitoring study was conducted in Manila the same air space does not eliminate nor Journal found that exposure to secondhand in February – May 2010 and involved 27 reduce SHS exposure. smoke increases the risk of heart diseases buildings (5 hospitals, 5 government offices, Attempts to control the toxic and among non-smokers by as much as 60%. 7 restaurants, 10 entertainment venues) cancer-causing properties of secondhand The science is clear on the dangers in Manila. All buildings were found to have smoke by means of ventilation and filtration of tobacco use but we also need clear, some form of evidence of smoking. Most are futile. It would require super-typhoon enforeable policies to reduce that use and to entertainment venues and restaurants had strength rates of air flow to put the level protect people from secondhand smoke. smokers present. Moreover, there was a low of toxins to a safe levels. The only effective Millions of Filipinos, both children presence of signages prohibiting smoking. means to eliminate the health risk associated and adults, are still exposed to secondhand Entertainment venues had the with indoor exposure to tobacco smoke is to smoke in their homes, workplaces and highest levels of PM2.5. In 30 minutes, clients ban smoking. public places. The Philippines Global Adult would be exposed to more than 6 times Please turn to page 21...

November - December 2010 I HEALTHbeat 19 20 HEALTHbeat I November - December 2010 Japan and South Korea. The study employed active

monitoring (PM2.5), passive monitoring (air nicotine) and simple observational monitoring of public places. In entertainment venues, restaurants, hospitals and government offices, all methods were employed. In schools, only air nicotine monitoring procedure was used. Secondhand smoke was estimated

by measuring PM2.5 using a TSI SidePak AM510 Personal Aerosol Monitor and air sampling of vapor-phase nicotine was done using a filter badge treated with sodium bisulfate

PM2.5 monitoring was conducted in a building for several hours (30 minutes Engr. Rene Timbang (right) of the Environmental and Occupational Health Office of the National in cafeterias, lobbies, restaurants, and Center for Disease Prevention and Control, the principal author of the study, and Anthony Roda (left) entertainment venues and 5 minutes of the National Center for Health Promotion, the co-author, during the WHO regional workshop on in stairways, hallways, toilets, lounges, Monitoring Secondhand Smoke Exposure in Kobe, Japan in July 2009. patient floors and offices), while air nicotine monitoring occurred over a 5 to 7 day period Continued from page 19... Experiences from other countries (5 days for office and school environments). The study also found that hospitals show that implementing 100% smokefree On the other hand, simple observational and government buildings were not 100% policies benefit nonsmokers and smokers monitoring of public places was made smokefree. Hospitals, where absolute alike. Nonsmokers are exposed to significantly using a questionnaire for recording the smoking ban is imposed under the law, had less secondhand smoke, while smokers number of people and smokers present,

PM2.5 levels slightly above the WHO standard. tend to smoke less, have greater cessation presence of cigarette butts, tobacco industry On the other hand, government offices got success, and have increased confidence advertisements, and no smoking signs. the lowest PM2.5 levels and did not exceed in their ability to quit. These effects are In addition, the room dimensions and the WHO standard. Under the Memorandum greater under a comprehensive ban rather characteristics as well as the presence of Circular No. 17 issued by the Civil Service than a partial one. When indoor smoking ventilation systems were recorded. Commission, smoking is absolutely prohibited areas are allowed, ventilation is inadequate The data gathered from the in government agencies providing health, to eliminate secondhand smoke, and the SidePak and samples collected by the air education and social welfare services, while reduction in smoking among smokers is less nicotine monitors were sent to the Johns other government agencies can designate significant. Hopkins Bloomberg School of Public Health smoking areas in open spaces 10 meters (JHSPH) for analysis. away from entrances, exits and where people Part of A Bigger Study As of this writing, only the PM2.5 data pass or congregate. were analyzed. The air nicotine data are still The study provided hard evidence The Philippine study is only a part of being processed by the Exposure Assessment to local government units on the impact a bigger study to characterize SHS exposure in Facility at JHSPH. After all data have been of secondhand smoke in public places and key indoor places in nine countries throughout completed, the cross-country comparison having a policies/ordinances aimed at Asia. Aside from the Philippines, the same that will examine the similarities/differences eliminating SHS exposure indoors will have study has been conducted in Bangladesh, and strengths/weakness between PM2.5 and direct benefits to public health. China, India, Indonesia, Thailand, Vietnam, air nicotine monitoring will be published.

November - December 2010 I HEALTHbeat 21 breast CANCER

Late stage breast cancer where survival is nil. This photo, courtesy of Dr. Maricar Limpin of the Framework Convention for Tobacco Control Alliance Philippines (FCAP), is one of the proposed Graphic Health Information photos to be placed on cigarette packs in the country. Piloting the Patient Navigation Program Patient Support and Free Medicines for Indigent Patients with Early Stage Breast Cancer

On October 29, the last working will promote early breast cancer detection care in government hospitals that is cost- day of the Breast Cancer Awareness Month, through pledge of patient support and access effective, humane and patient-centered. the Department of Health, Philippine Cancer to free medicines in order to improve breast The four government hospitals Society, Inc. (PCSI) and four Metro Manila cancer survival rates of women in the lower in the pilot project include the East Avenue government hospitals forged an agreement economic status. The program provides a a Medical Center (EAMC), Jose R. Reyes to pilot the Patient Navigation Program that multidisciplinary approach model for cancer Memorial Medical Center (JRRMMC), the

22 HEALTHbeat I November - December 2010 Philippine General Hospital (PGH) and Under the pilot project, a total of program director of the DOH National Center the Rizal Medical Center (RMC)− all 795 targeted indigent patients at the early for Pharmaceutical Access and Management, having the capacity, support facilities and stages (Stage I – IIIa) has been identified the Patient Navigation Program is not a a multidisciplinary team of experts for and divided into the four hospitals as follows: new concept and has already been proven managing breast cancer. These hospitals 115 patients for EAMC; 220 for JRRMMC; 400 as a successful model of cancer care in US also cover the catchment areas of the Metro for PGH, and 60 for RMC. minority populations which began in the Manila Cancer Registry and the Rizal Cancer An expert committee was also 1990s. Locally, patient navigation services Registry which are the main sources of data formed to help the DOH craft a resource- are already being provided for indigent for cancer incidence in the country. appropriate and cost-effective treatment breast cancer patients at EAMC. Dr. Rachel Marie Rosario, PCSI protocol for early stage breast cancer that can Moreover, So said that medicines executive director, said, “Cancer is an be implemented in government hospitals. access program is incorporated in the expensive disease and can really drive Aside from medical specialists from the PCSI working draft of the Philippine Medicines patients to poverty because of the huge and the four pilot hospitals, the committee Policy wherein it is stated that “The DOH, out-of-pocket expenses it requires. We can also involves experts from the Philippine PhilHealth (Philippine Health Insurance never really stop women from dying until College of Surgeons and the Philippine Corporation) and other relevant government our efforts at early detection are linked to Society of Medical Oncologists. agencies should strive to employ strategies cost-effective care and treatment.” According to Dr. Robert Louie P. So, that will provide free medicines to the poor Health Secretary Enrique T. Ona also expressed full support to the new partnership adding that providing medicine entitlements to poor and vulnerable sectors for priority diseases like cancer is a move that will be pursued by the DOH within the next five years. The new venture between the DOH and PCSI, which have been partners for almost three decades in combating cancer in the Philippines, is in line with the Aquino administration’s Public-Private Partnership initiative towards Universal Health Care. Under the partnership, the DOH will provide financial and logistics support for the Patient Navigation Program and coordinate with the local government units and participating hospitals within Metro Manila and Rizal province. The PCSI will implement the patient navigation scheme using the standardized breast cancer treatment protocol, train or hire patient navigators to be deployed in access sites, conduct patient follow-up and monitoring, and conduct research to improve breast cancer treatment in the The Pink Ribbon, a symbol for Breast Cancer Awareness. Photo source unknown, taken from a powerpoint country. presentation of Dr. Robert Louie P. So.

November - December 2010 I HEALTHbeat 23 or a population of patients that CLINICAL STAGE DIAGNOSIS OF BREAST CANCER IN THE PHILIPPINES addresses priority diseases (e.g. TB, HIV, malaria, NCDs, cancers).” The Patient Navigation Program reduces barriers to health care, prevents delays in diagnosis and treatment, and improves the quality of life of cancer patients undergoing treat- ment by providing psychosocial support.

Early Diagnosis in Breast Cancer The stage at which breast cancer is being diagnosed in the country has not changed. Most cases are diagnosed at stage According to the II and above. While Stage II still has a good prognosis, it usually requires more expensive chemotherapy. SOURCE: Philippine Cancer Facts and Epidemiology and Clinicopathology of Breast Cancer in Metro Manila and Rizal Province, Philippines. Laudico, A., Estimates 2010 published by the Redaniel., MT, Mirasol-Lumague,R., et al. Published in the Asian Pacific Journal of Cancer Prevention. PCSI, breast cancer is now the leading cancer site overtaking lung cancer certain cancers, particularly in the past three changed through the years and most cases for both sexes in the Philippines (i.e. 15% of decades. In the USA, both cancer incidence are diagnosed at stage II and above, whereas all cancers). It is also the number one cause and mortality have declined since peaks detection at Stage I remains poor despite of cancer illness and death among Filipino in the early 1990s because of heightened desperate calls for early screening and women accounting for almost 30% of all awareness, prevention, earlier detection, detection. (See Table in this page.) While female malignancies. and the availability of new and more Stage II still has a good prognosis, it usually Breast cancer cases are projected effective treatment regimes. While the DOH requires more expensive chemotherapy. to increase in the Philippines in the coming and other cancer prevention advocates are So said that the Patient Navigation years with factors such as smoking, constantly harping on early screening, it is Program intends to see more and more unhealthy lifestyles and decreasing fertility. still a puzzle why women in the Philippines patients to get diagnosed at stage I, the It is estimated that there will be a total of continue to be diagnosed relatively late into way it is happening in other countries. For 12,262 new breast cancer cases in 2010 with the disease. Studies show that many factors example, among Filipinos in the US, up to 4,371 deaths. Latest data also reveal that act as barriers for our women when they 37% are being diagnosed at Stage I and 47% three out of every 100 Filipinas are likely to get breast cancer. Cancer is a devastating are diagnosed at Stage II. Thus, the much develop breast cancer in their lifetime and and disfiguring disease and thus a cancer improved survival rates. that one out of every 100 are likely to die diagnosis often elicit fear among women. “There can be no cancer control from the disease before age 75. A significant barrier, particularly without prevention and treatment,” So In Asia, the Philippines is in the Philippines, is the high out-of-pocket said. And quoting an article “Expansion among the countries with the highest cost for cancer treatment. There is also lack of cancer care and control in countries of age standardized incidence rate for breast of health system infrastructure and expertise low and middle income: a call to action” cancer. Survival rate for breast cancer in for breast cancer patients especially in the published in the Lancet (August 2010), the Philippines is below 40%. In developed provinces. he emphasized that “neglect of care leads countries like US, Canada, Australia, survival A study done on the breast cancer to unnecessary death and suffering, and rates (80-90%) have significantly improved incidence in Metro Manila and Rizal showed neglect of prevention leads to unaffordable in the last decades. Wealthy countries have that the stage at which breast cancer is treatment.” made major strides in the fight against being diagnosed in the country has not - o O o -

24 HEALTHbeat I November - December 2010 COVER story HIV “Si Heidi, si Ivy at si V”

The HIV Indie Film movie tills. Indie films are said to tackle someone can produce a movie in accordance more serious societal issues more freely and with his/her own personal taste and style The Department of Health co- made more artistically. In fact, indie films without the vested commercial interests and ventures with Exogain Productions in the become so prominent in the country that influences of mainstream movie studios. newest trend of disseminating health many believe that these films have salvaged Early this year, when HIV/AIDS messages to the public via an “indie film.” the almost dying Philippine movie industry. (human immunodeficiency virus / acquired Indie or short for “independent” Almost all indie films are not shot immune defficiency syndrome) resurfaced films are movies not made by the so-called and shown in the expensive 35-milllimeter as a hot issue in news and media, Donna mainstream or bigtime movie outfits or film but in digital video tape format. The Sanchez and Maria Isabel Lopez proposed to studios that tend to make big-budgeted emergence of digital cameras and their then Health Secretary Esperanza I. Cabral to films with formula and tested storylines high-technology accessories in the market make a movie about HIV/AIDS. After several and scenes, and capitalizing on big named have spawn the growth of indie films. Thus, meetings and consultations with the staff and pricy stars to cash in big bucks in the with a couple of millions pesos or even less, of the National AIDS Prevention and Control Program under the DOH National Center for Disease Prevention and Control and the National Center for Health Promotion, the movie started reeling. The movie is directed by Neal “Buboy” Tan from the screenplay of Wanggo Gallaga, the son of a critically acclaimed film director, Peque Gallaga. When Wanggo publicly announced in 2009 that he was HIV positive, it sent a powerful message that anyone can get HIV.

Synopsis

HIV (Si Heidi, Si Ivy at Some of the major cast of HIV, The Movie. FRONT ROW from left: Maria Isabel Lopez, JP Mesde (partly hidden), Jake Si V) is based on real stories and Cuenca, Isa Calsado and Candy Pangilinan. RBACK ROW from left: Mara Lopez, Jao Mapa, Abby Cruz and Will de testimonials of people with HIV/ Vaughn. Please turn to page 28...

November - December 2010 I HEALTHbeat 25 si Heidi si Ivy at si V?

26 HEALTHbeat I November - December 2010 Photos courtesy of Exogain Productions

November - December 2010 I HEALTHbeat 27 HIV ALL STAR CAST

Jake Cuenca Maria Isabel Lopez Iza Calzado Candy Pangilinan IC Mendoza JP Mesde Precious Lara Quigaman Will de Vaughn Jao Mapa Abby Cruz Mara Lopez Azenith Briones Orestes Ojeda Liz Alindogan Jess Santos and Rustica Carpio

With Special Participation of: Dr. Esperanza I. Cabral Dr. Gerard Belimac Department of Health staff and Philippine National AIDS Council members

SEATED from left: Jake Cuenca and Lara Precious Quigaman. STANDING from left: Neal “Buboy” Tan ... Continued from page 25 (director), Donna B. Sanchez (executive producer) and Wanggo Gallaga (scriptwriter). AIDS. Gil Bustamante (Jake Cuenca), a visual a time he worked as a contractual employee young cheery gay and a stand-up comedian designer and a young filmmaker launches in Bahrain. Her husband died of AIDS three who engages in different sexual pleasures. into a story that fuses patients with HIV/ years previously, leaving behind a 9-year old Heidi struggles very hard to make AIDS cases. Using the San Lazaro Hospital son, Victor (JP Mesde) also an HIV patient. ends meet by selling packed food in offices as backdrop, you will find young adults, Ivy (Iza Calzado), a young call center agent, and nearby streets, until her condition some men who have sex with men, people two years fresh from graduation, discovers becomes worse. Now waiting for her in prostitution, and intravenous drug users, she is HIV positive. It is about her life that is time, she decides to tell her story to give among others. about to begin and she must now face the the AIDS awareness more substance, and The documentary focuses on three world – her work, family, and friends – with hopes that by coming out, less people will major characters namely Heidi, (Ma. Isabel a mistake from her past. She is about to contract the virus. But before completing her Lopez) a plain housewife who contracted the apply for work abroad when she learns she documentary, she dies. virus from her philandering husband during is HIV positive. And Vanessa (IC Mendoza), a Ivy tries to discover how she got

28 HEALTHbeat I November - December 2010 In the end, with the support of his family, he goes public with the truth that he too is HIV positive. Gil is not gay, but he has had multiple sexual partners of both sexes. Coming out in the open is the most significant decision he has made in life, and telling the public that the fight against HIV/AIDS is not solely the responsibility of the government as it is a fight that demands action from every individual.

Spread the News, Not the Virus

Health Secretary Enrique T. Ona, in his message before the movie starts emphasized that there is still no cure for HIV and AIDS , thus making it one of the major social and developmental issues faced by the world today. He said that the HIV movie is part of the government’s effort to combat the HIV/AIDS and spread hope for a better understanding of the disease. Ona said that the movie is “a story about the reality of HIV and AIDS, its effects on the individual, the family and the community. Providing adequate and appropriate information, education and health services to control HIV and AIDS is essential in giving persons living with HIV a free environment to share their experiences TOP: Health Secretary Enrique T. Ona (seated fronting the camera) films his message for the movie. and to give the community a better view of Standing on the left is Maria Isabel Lopez. BOTTOM: Sec. Ona with Jake Cuenca (left), Iza Calzado (second how HIV transmission could be prevented from right) and DOH Director Enrique Tayag (extreme right) during the HIV movie’s press conference. and managed.” (Photos by Paking Repelente) He called on the viewers to be the virus since she never had sex with anyone Gil’s frustration in covering their responsible and stay safe. “Spread the news, except her ex-boyfriend, Arnel, who turned stories becomes the next focus of the movie. not the virus,” Ona concluded. out to be HIV negative. She suspects she got He used to be an outgoing person, confident “HIV - Si Heidi, Si Ivy at si V” the virus during their graduation party when and friendly in social situations. Playboy premiered on December 1, World AIDS Day everyboey was intoxicated or drugged. and very romantic, he enjoyed drinking and at SM Cinema. Exogain Productions intends Vanessa, on the other hand, partying. His advocacy on HIV/AIDS started to show the movie on special screenings continues his stint as an entertainer. A gay when he was assigned by the DOH to make a nationwide and even in some parts of the who cruises around at night to have sex with documentary film on the lives of some of the world. After a year, the DOH will use the indie different men, until finally he gets nabbed patients. But only a few agree to come-out movie as part of its health promotion and and is almost killed by a group of men he in the open with their stories. Like them, he HIV/AIDS prevention and control advocacy had sex with. is afraid. activities.

November - December 2010 I HEALTHbeat 29 sexual DYSFUNCTION Vaginal Lock Is it Real and Is it Rare? by DONATO DENNIS B. MAGAT HEALTHbeat Staff

Vaginal lock during (PC) muscles group are the heterosexual intercourse – is it predominant pelvic floor muscles real and is it rare? during bouts of vaginismus. Vaginismus, or what This PC muscle group enables a is now also being termed as woman to urinate, have sexual “vaginal lock” or “vaginal or intercourse, reach orgasm, move penis captivus,” is a tightening of bowels, and deliver babies. the vagina when a foreign object Oftentimes, vaginismus is inserted into it. The insertion is the culprit in unconsummated of anything causes women marriages/relationships because discomfort, pain, penetration it makes penetration very problems or complete inability difficult or impossible. Vaginal to have a satisfying sexual tightness can be so restrictive intercourse. that the opening is ‘closed’ to Vaginismus is a allow penetration of the penis. condition where there is The pain experienced by a involuntary tightness of the woman ends when the sexual vagina during attempted attempt ends. intercourse. The tightness is The mystery of having caused by the involuntary the problem (vaginismus) contractions of the pelvic floor can be very distressing and muscles surrounding the vagina, frustrating to both women and specifically the pubococcygeus their partners. Women may (PC) muscle group. It should feel ashamed to discuss their be noted that the woman has condition, not even with their no control on the tightness husbands/partners, and may be occurring on her pelvic muscles. force to keep their suffering in Neither is she aware that her private. muscles’ response is causing An article entitled The pelvic floor muscles surrounding the vagina. SOURCE: (Top) Mayo the tightness or penetration Foundation for Medical Education and Research. (Bottom) A.D.A.M., “Critical Literature Review on problem. an innovative online technology solutions for the health, benefits, and Vaginismus,” copyrighted to The pubococcygeus education. the University of Melbourne,

30 HEALTHbeat I November - December 2010 Australia, Faculty of Medicine and posted traumatic event, childbirth, surgery or However, when the attempt to on the Vaginismus Awareness Network, menopause. insert anything to the vagina ends, the stated that, “The term vaginismus is still In some occasions, women who vaginal wall begins to relax and normalize. not part of people’s everyday vocabulary experience pain or difficulty of being For this reason, medical examinations often and seems absent from the media and from penetrated, difficulty inserting tampon, or fail to reveal any apparent problems unless most material published on sexuality, some even a doctor’s speculum often mistakenly the tightness occurs and is noted during sufferers feel that it is ‘an invisible handicap.’ thinks that their vagina is too small. Health pelvic examination. This silence may also contribute to the false experts said that involuntary constriction of Depending on the intensity, impression that this is a rare condition.” the vaginal muscles is the main cause of the vaginismus symptoms range from minor The article continued, “Although problem. They added that no matter what burning sensations with tightness to total a prevalence rate has not been assessed the woman’s physical height, size, or age, the closure of the vaginal opening making scientifically, estimates of vaginismus range vagina is physically able to accommodate a penetration impossible. Common symptoms from 5% to 47% of people presenting for sex man’s penis of any size. In extreme cases, the of vaginismus include burning or stinging therapy or complaining of sexual problems, vagina can widen to accommodate delivery with tightness during sex, difficult or with significant differences across cultures. of a baby during childbirth. impossible penetration, uncomfortable Despite the lack of consensus on prevalence, There are several risk factors insertion of penis, ongoing sexual what is agreed upon is that large numbers of that may make a woman more prone to discomfort/pain following childbirth, urinary women possibly do not ever come to clinical developing vaginismus. Some of these infections, sexually-transmitted diseases, attention, yet reasons for this low presence contributing factors are: pelvic pain due hysterectomy, rape, menopause, cancer, or have not been explored. Unlike other sexual to a medical condition, infection, physical other medical conditions, difficulty inserting dysfunctions or genital problems, vaginismus trauma, age-related changes, emotional tampons or undergoing pelvic/gynecological prevents both intercourse and the ability distress, anxiety, fear, or other similar examination, spasms in other body groups to conceive, it seems likely that society’s emotions that relate to sex, intimacy, past such as legs and/or lower back. expectations of women’s sexuality may trauma or relationships. Vaginismus can happen in both particularly impact on these sufferers.” If left untreated, the condition younger and older women, and those with Vaginismus can be either primary or often worsens, because the experience of no sexual experience or those with years of secondary. Primary vaginismus occurs when ongoing sexual pain further increases the experience. Not all women experience the a woman has never experienced painless duration and intensity of the involuntary same degree of difficulty. Some women are intercourse or any vaginal penetration. PC muscle contraction. It can also impede unable to insert anything at all, some are Usually, it is discovered when a woman a woman’s ability to experience orgasm unable to insert a tampon or complete a attempts to have sex for the very first time. during intercourse, as sudden pangs of pain gynecological examination, others are able The spouse/partner is unable to penetrate terminates the arousal buildup. to partially insert a penis but with much and seems to bump into ‘walls’. Women difficulty and pain, some are able to fully with this condition are also unable to wear insert a penis but tightness and discomfort tampons and/or complete pelvic exams. interrupts arousal and orgasm, some may Many couples are unable to consummate be able to tolerate years of discomfort their relationship because of this rare during intercourse with gradually condition. increasing pain. Some women can With vaginismus, also develop vaginismus in the mind and body have later life, even after years of developed a conditioned pleasurable, pain-free sexual response against any form intercourse. This condition is of penetration. The body has referred to as secondary vaginismus. learned to anticipate pain upon This is precipitated by a medical condition, penetration, so that the PC muscle

November - December 2010 I HEALTHbeat 31 group contracts to protect against the pain from difficult vaginal deliveries, difficulty during sexual encounter. potential/expected pain from intercourse or miscarriages, menopause and hormonal For women with penetration any penetration. changes, vaginal dryness/inadequate difficulties, techniques must be learned to Examples of non-physical causes of lubrication, vaginal atrophy, discomfort allow initial entry without experiencing vaginismus are fear of pain from intercourse, from insufficient foreplay, sexual/physical pain. In this technique, women may allow fear of not being completely physically abuse, or rape. the entry of small object like cotton swab, healed following pelvic trauma, fear of Vaginismus is considered one of tampon or finger into their vagina, working tissue damage, fear of getting pregnant, the most successfully treatable female sexual completely under their control and pace. performance pressures, previous unpleasant disorder. Successful treatment of vaginismus Women should learn to take full control of sexual experiences, negativity toward sex, does not require drugs, surgery, hypnosis their pelvic muscle group and learn how to partner abuse, fear of commitment, distrust, or any other complex, invasive technique. flex and relax at their own will. past emotional sexual abuse, unbalanced Effective treatment approaches combine Another form of treatment is religious teaching like sex is bad, and pelvic floor exercises, insertion or dilation by using a dilator. It should be noted that inadequate sex education. training, pain elimination techniques, dilators are typically ineffective when used Life experiences vary from person- transition steps, and exercises designed to without guidance. Dilators are only one to-person and these experiences play a big help women identify, express and resolve aspect of treatment, and should be combined part in triggering vaginismus condition. contributing emotional components of the with proper pelvic control techniques. The Sometimes women with happy childhood problem. main focus of the dilator is in retraining the memories, great relationships, good One effective treatment for pelvic floor, but not stretching the vaginal education and fewer anxieties also find vaginismus is focused on retraining the pelvic opening. trouble having a gratifying sex life. muscles to eliminate involuntary muscle With proper guidance and Some physical causes of reactions that produce pain or tightness techniques, this female disorder can be vaginismus include urinary tract infections, in the vaginal opening. Learning how to addressed. Moreover it needs the help, sexually transmitted-disease, genital/pelvic exercise and retrain the pelvic muscles is an patience and understanding of the spouse/ tumors, cysts, cancer, eczema, psoriasis, important step in eliminating tightness and partner in dealing with this condition. HEALTH advisory KALUSUGAN SA KAPASKUHAN • Plan your Christmas activities. Don’t intake of salt, sugar and fats. Add more • Choose your Christmas lights and spend beyond your means. Manage fruits and vegetables in your Noche decors well. Don’t overload your your stress. Buena and Media Noche meals. electrical outlets and extention cords to prevent fire. • Take care of your health against • Limit alcoholic drinks or better yet the sudden changes in temperature. don’t drink at all, especially when you • Give age-appropriate toys to Cough, colds, fever and flu are are driving. children. Avoid toys with pointed or frequent this holiday season. Consult sharp edges or toys that have small your doctor if symptoms persists in • Don’t forget your daily dose of parts that can choke. more than five days. physical activity and exercise. • Make some noise without using • Eat right, eat healthy. Limit your • Get enough sleep. firecrackers, fireworks and guns.

32 HEALTHbeat I November - December 2010 Islam & HEALTH weighty problem by TATO M. USMAN, MD, MPAIM DOH Center for Health Development - Autonomous Region in Muslim Mindanao

Obesity has reached epidemic For type 2 diabetes alone, the protein, fat and carbohydrate). proportions globally, with more than 1 American Journal of Epidemiology revealed: Additionally, Allah Almighty has billion adults overweight - at least 300 • Each unit increase in Body Mass established in all matters including balance million of them clinically obese - and is a Index about 2.7 – 3.6 kg) increases type 2 diet: “And He enforced the balance. That major contributor to the global burden of diabetes risk by 121%; you exceed not the bounds; but observe the chronic disease and disability, according to • 68 – 72% of diabetes risk in the balance strictly, and fall not short thereof” the World Health Organization (WHO). U.S. is attributable to or associated with (Chapter Ar-Rahman: Verse 7-9). In the Philippines, the 2003 excess weight; and Meaning, you need to balance National Nutrition and Health Survey of • For every kilogram increase in your energy intake and expenditures in order the Food and Nutrtion Research Institute weight over 10 years type 2 diabetes risk to maintain your ideal healthy weight. Your (FNRI) revealed that 90% of Filipinos have increases 4.5%. estimated energy requirement is calculated one or more of the six prevalent risk factors Likewise, WHO states that obesity by multiplying your basal metabolic rate by for chronic disease, particularly overweight reduces life expectancy by 5 years. your physical activity coefficient. (20%) and obesity (4.9%). The key causes are increased The Prophet, peace and blessings Meanwhile, the 7th National consumption of energy-dense foods high be upon him, is reported to have said: “When Nutrition Survey (2008) recorded asignificant in saturated fats and sugar, and reduced filled with food, the belly becomes the worst increase in the prevalence rate of Filipinos physical activity. container for the son of Adam. It is sufficient who are overweight and obese from 2003 to In Islam, Muslims are encouraged for a human being to have a few bites to keep 2008. The overweight prevalence rose from to eat moderately and avoid excess. Allah himself fit. If one must eat, then let him use 15.2% to 21.4% while obese prevalence Almighty said in the Noble Qur’an: “Eat and one-third for food, one-third for drink and stepped-up from 3.4% to 5.2%. drink, but avoid excess...“ (Chapter Taha: one-third for breathing”. Overweight and obesity pose major Verse 81). When the Prophet, peace and risks for chronic diseases, including type 2 Obviously, if you take excess blessings be upon him, met a very fat person diabetes, cardiovascular diseases, hypertension amount of energy more than the needs of with a very big belly, He pointed to the man’s and stroke, and certain forms of cancer such your body, you will gain weight (energy belly and said: “If this was not there it would as breast, endometrial and colon cancer. is supplied from macronutrients such as have been better for you”.

November - December 2010 I HEALTHbeat 33 HEALTH etiquette

How do you COUGH & SNEEZE ? Many of us were told by our evidence-based research says that nothing Don’t cough onto your bare arms parents and teachers to cover our nose and beats good old soap and water for washing or hands or you’ll continue to spread germs. mouth when we cough or sneeze, especially hands; however, sanitizing gels have their You must cough into fabric. We just hope when we’re out in public. This is a sure way place when access to a restroom is limited. that in this season of cold weather you wear to prevent the spread of airborne diseases, USE A TISSUE, BUT… If a tissue at least a short sleeved shirt in order for you but how we do it is what matters. It’s the flu is used, it should only be used once and to cough and sneeze this way. season and this is the right time to re-learn followed immediately with hand washing. OTHER ADVICE THIS FLU the basics of coughing and sneezing. Throw the tissue in a trash after you use it. SEASON. If you can afford it or if it is DON’T USE YOUR HANDS. Most Don’t think of reusing a used tissue because available for free in your area, take the time people put their hands in front of their once your hands touch it again, germs begin to get your flu shot. If you’re already healthy, mouths and noses to stop germs from getting to spread. it can reduce your chance of illness by 70- into the air. Unfortunately, this technique Using a handkerchief is another 90%. We just cannot over emphasize to wash puts the germs on their hands. The germs option, though regular cleaning would your hands often or use hand sanitizer after are then spread to doorknobs, telephones be essential, otherwise you would just be touching surfaces others may have touched. and many other objects from which they are carrying around a germ rag in your pocket or Avoid touching your eyes, nose or mouth with then picked up by the next user. This is how purse. unclean hands. Germs spread this way. colds spread quickly through schools and USE YOUR SHIRT SLEEVE. Try to avoid close contact with sick workplaces, and how the flu spreads quickly The US Centers for Disease Control (CDC) people. If you get sick with influenza, health through entire communities. recommends to turn your head to your shirt experts recommend that you stay home from If you are caught by a sudden sleeve to cover your nose and mouth when work or school and limit contact with others burst of cough or sneeze and you cannot you cough or sneeze. This is also called the to keep from infecting them. If you are ill and do anything but use your hands to cover “Dracula Approach” which is to sneeze and need to go in public, consider wearing a face them, wash your hands immediately before cough into your elbow, as if you are drawing mask to prevent cough and sneeze droplets touching any objects. Alcohol-based hand up your arm in a cape. The fabric will absorb from spreading to others. sanitizers are also effective. But just a note, the germs from your cough or sneeze. - o O o -

34 HEALTHbeat I November - December 2010 personal HEALTH when ALLERGY gets in the way of VANITY by Paul Ritz MagtrayoArt by ANTHONY R. RODA, MaHeSoS HEALTHbeat Staff

The Scare of My Life or text, I took antihistamine twice daily afraid to die. for less than a week and that relieved my Yeah, my colleagues and closest condition. But in August, when I went to Aging, Vanity and Allergy friends know that I have a death wish at my barber to dye my hair once more, the 50 years old. I always tell myself that I will swelling and itching came back with full Finally I saw myself consulting not grow old despite my having the “ageing gravity and lasted for more than two weeks. with a doctor after almost a month of genes,” if there is such a thing. You see, The anti-histamines I took were not working unsuccessful self-medication. I told the lady majority of my relatives reached old age. anymore. dermatologist of my situation, particularly Worse, I have a 50 percent chance of getting And then the scare of my life the swelling behind my ear. She said that I Alzheimer’s. That’s why I don’t want to get happened! I felt a swollen and tender am allergic to hair dyes and that the “mass” old, although I have the smoker’s skin and mass behind my ear down to the neck area behind my ear was swollen lymph nodes or wrinkles, beer belly and balding hair. At 47, which was very painful when touched. “My kulani. my friends – or should I call them such – say goodness, I have neck cancer,” I said to myself I was both relieved and surprised. I’m already old. Huh?!? and I was blaming my years of smoking and I was happy to find out that it was not (yet, I’m getting self-conscious with nicotine addiction! anyway) neck cancer, but I was also surprised my age that’s why most of the time I think I thought it was the right moment to know that there were lymph nodes behind young to the point of being childish even. to consult a doctor, but which doctor the ears. I always thought that lymph nodes Hehehe. Adding to my sorrowful miseries is – an oncologist, an ENT (ear nose, throat) are only located in the underarms, inguinal my graying thin hair. specialist or a dermatologist? I chose the area or in the groin, and under the chin. It was only this year that I began lesser degree of illness, skin disease, and At my age and several years of working in dyeing my hair black every other month. turned to the dermatology department of the Department of Health, I’m still learning The first two dyeing experiences boosted my the Jose R. Reyes Memorial Medical Center something! morale, vanity-wise. The third time I dyed (JRRMMC). And now the sad part. The my hair in June was a different story. My “It’s only an itch and not cancer,” I dermatologist told me that I had contact scalp began to swell and itch. As per advise comforted myself. For someone who has a dermatitis and advised me to refrain from of a doctor-friend through short messaging death wish at 50, I was not ready and was so using any kind of hair dyes. “Whaaaaat?!?,”

November - December 2010 I HEALTHbeat 35 I was screaming in silent protest. Then I skin allergy patch test for me to find out for amount of substance is injected into the skin. reasoned that there are hypo-allergenic myself which substances that I am allergic to. The intradermal test may be done when the hair dyes or something. But the doctor who Betting against all odds that her diagnosis skin prick test is negative but the person is seemed to empathize with me, said that I was wrong, I readily agreed right then and still thought to be allergic to that substance. cannot use all hair dyes, and politely added there. This test is usually used to identify allergies that gray hairs would still look nice on me, to bee stings and other insect venom, or and pointing out to the wisdom that gray Skin Patch Testing penicillin. hairs symbolized. Then, there is the patch test that “Yeah right, I would look more like Skin testing for allergies is used to I underwent. The substance is placed on a a dirty old man than a wise man,” I thought. identify substances that are causing allergy patch and the patch is placed on the skin Then I dreaded people asking for my senior symptoms.The three main types of skin tests for up to two days. This test shows whether citizen’s card for discounts. My mind was are the scratch test, intradermal test, and the a person develops contact dermatitis (rash), flying off already and I could see myself patch test. which is an allergic reaction on the skin due having a Php 4 change from the Php 10 that In skin prick or scratch test, a to direct contact with an allergen such as I would give the jeepney driver for my fare. small amount of substance is pricked or latex, medications, or fragrances. Ouch! scratched on the skin with a sterile needle. Patch test is done every Monday The dermatologist was already If the area becomes red, itchy, or swells, to Wednesday at the JRRMMC, and the cost filling up her prescription pad, when I said the allergy skin test is positive. If there is amounts to Php 800. Before performing again, “Are you really, really sure that I could no reaction, the test is negative. This test is the actual test, I went through an extensive not use hair dyes anymore?” I saw a faint usually used to test for allergies to pollen, interview with a medical staff. I was asked smile before she said yes. And to end my mould, pet dander, dust mites, and foods. about my work and my work environment. persistence, I suppose, she recommended a In intradermal test, a small Then, and she made a run through of a list

Patch Testing at Dr. Jose R. Reyes Memorial Medical Center. It involves the placement of various chemicals into small metal cups affixed to paper tape. The tape is then placed onto the skin of the back. (Photos by Weng Bunoan)

36 HEALTHbeat I November - December 2010 Share your PERSONAL Art Source:Art blogadorn.com exclusive of substances and chemicals that may have Common allergens include rubber, metals caused me allergies in the past. I told her of HEALTH such as nickel, costume jewelry, perfume, few incidents where I got allergies: using STORIES cosmetics, hair dyes and weeds, including metal frames in my eyeglasses, wearing poison ivy. It may take several years for locally-made leather strap on my watch, and with us. an allergy to develop. Once an allergy has spraying certain brands of cologne. Other developed to a specific substance, however, than those items, I was just fine with her list it remains for life. Exposure to even a small of allergens. Then, she told me to stop taking Write your story or we will send a writer amount of the allergen will reliably result in antihistamines while on a patch test as this nearest you to do your story. Contact us at skin eruption. could interfere with the results. [email protected] My final diagnosis is “chronic The patch testing that was made allergic contact dermatitis” and my allergens on me involved a kit of 25 various test placement. This was another day without are paraphenylenediamine (PPD), Nickle, substances placed to my skin under adhesive bathing for me. I was also told not to touch and Quinoline. What are those? tape. The purpose of the patch test is to help or scratch my back, and to have somebody PPD is a chemical found in hair identify which substances may be causing my mark my back again in case the ink was dye that is very frequently used in hair allergic reaction. It is intended to produce a erased in time of my next consultation. salons and at home. Dyed hair cannot local allergic reaction on a small area of After three days, the final reading cause an allergy but the dye may do during the back where the diluted chemicals were came and this was referred to my attending application. It is also found in skin paints and planted. The chemicals included in the patch dermatologist. I was not DYING (yet), but the occasionally in fur and leather dyes. It is also test kit are the offenders in approximately verdict was more of a death sentence to me found in printing inks and oils as well as in 85-90 percent of contact dermatitis, like because I was told that “I’m not DYEING (my photocopying powders. chemicals present in metals (e.g. nickel), hair) anymore!” Nickle is found in jewellery, keys, rubber, leather, hair dyes, formaldehyde, coins, zippers and buckles, pacemakers, lanolin, fragrance, preservative and other What’s My Itch? batteries and metal eyeglasses. It is released additives. from metals such as alloys or electroplated The adhesive tape that was used There are two types of contact items. About 10 percent of women and at had small metal cups in which the substances dermatitis: irritant contact dermatitis and least 1 percent of men are affected by nickel were contained, and this was attached on allergic contact dermatitis. allergy, and I am one of them. Tough luck. my back. The patch test remained on my Irritant contact dermatitis is more And quinoline is an oily colourless skin for 48 hours, and during this time, common and results from repeated contact compound used as a food preservative and I was not supposed to get the tape wet. with a substance, such as soap, cosmetics in the manufacture of antiseptics, creams, Therefore, I only took a sponge bath on the or skin products, including deodorant, that ointments, lotions, and you guessed it, hair upper portion of my body. I felt some kind irritates the skin. The exposure produces dyes. of a “manananggal” (or a half-body creature red, dry itchy patches usually on the hands, Aside from giving me the detailed of the dark in Philippine folklore) while fingers and face. Some substances, such information about sources of my allergen, bathing. I should not also get the tape wet as bleach or strong acids, can cause irritant the dermatologist also advised me to by excessive sweating, and so I took a sick contact dermatitis after just one exposure. scrupulously avoid any further contact with leave at work the following day. These substances typically remove oil and the allergens. She also said to carefully read After two days, the patch test the protective barriers from the skin. ingredients of new products, especially was removed and an initial reading of the On the other hand, allergic cosmetics. test was performed by the medical staff. A contact dermatitis is caused by a reaction Finally, I was also told with great permanent marker was used to mark on my to substances called allergens. The resulting conviction now, “NO HAIR DYES!” Yeah right, back where the tests were prior to removal, reaction is your body’s response to the you want me to look very old,” I said to myself. for an additional reading of the results at 72 sensitive agent. It produces a red rash, And then she added, “Use baby soap.” Is that hours (or on the third day) after the initial bumps and sometimes blisters when severe. adding insult to injury already?

November - December 2010 I HEALTHbeat 37 LAUGHTER heals batambata ka pa Mathematics Layas!

IGGY: Daddy, patulong naman sa LEVY: Layas! ‘Wag ka nang babalik! assignment ko, o! Find the least Simula ngayon, ‘wag mo na kong common denominator daw. tawaging Nanay at hindi na rin BENJIE: Ha? Elementary pa lang ako kita tatawaging anak, eh hinahanap na nila yan ah! naintindihan mo ba ‘yun? Aba’y hindi pa pala nila nakikita! MARVIN: Sige dude, alis na ‘ko. Paulo Caguioa, first self-portrait.

Assignment Surprise! Emergency MARK: ‘Nay, ako lang po ang nakasagot Naghihingalo na ang Itay dahil sa malubhang sa tanong ng teacher namin! Isang binatilyo ang naputulan ng parehong karamdaman... BETH: Wow, ang galing mo naman, braso, pagdating niya sa ospital... ENTENG: Itay, ano po ba ang gusto n’yo, anak! Ano ba ang tanong? magpalibing o magpa-cremate? MARK: Sino ang walang assignment? KEN: (Pasigaw) Duktor! Gamutin n’yo EDONG: Ikaw na ang bahala, anak. po ako! Naputol ang dalawa kong I-surprise mo na lang ako! Exams braso! DOK: Mga anong oras ka ba naputulan? Cremation ROMY: Ang ganda ng ngipin mo, KEN: Mga 6 na oras na po. parang exams! DOK: Anim na oras? Eh bakit ngayon ka Sa paligid ng crematorium, nakatayo ang ARIEL: Ha? Bakit mo naman nasabi yan? lang pumunta dito? lahat sa gitna ng nakakabinging katahimikan. ROMY: Tingnan mo ‘yang ngipin mo KEN: HALLER! Mahirap kaya pumara ng Hanggang magsalita ang isang bata... one seat apart!!! jeep!!! PAENG: ‘Nay, hindi pa ba luto? Lakwatsa Nagloko Libing TITSER: Kaya mga bata, gayahin ninyo ang langgam. Masipag, TOPE: Nay, nagloko ba si lolo noong PARI: (Sa huling bendisyon bago ilibing) nagsusumikap at hindi buhay pa sya? Siya ay isang tapat at mabait na naglalakwatsa. LUZ: Pag namatay ako, tatangungin ko asawa at responsableng ama! LANCE: Kalokohan ‘yan Ma’am! Kanina sIya sa langit. JOSIE: (Bumulong sa anak) Anak, silipin lang ay nasa Luneta kami, TOPE: Eh kung nasa hell po si lolo? mo nga ang kabaong. Baka hindi nandun din sila! LUZ: Tatay mo ang magtatanong! Tatay mo ang nandiyan.

(-: Jokes and photo from the Internet :-)

38 HEALTHbeat I November - December 2010 Year-end review Health News: Top 10 in 2010 It’s the time of year when the later the names of the couple and the hospital to their profession because it drags the issue events that transpired in the recent past is were revealed. According to reports, Shaina of patient’s confidentiality and borders on recalled hoping lessons could be learned Magdayao suffered from vaginal captivus, an medical ethics. Those in the medical and from them. This is Healthbeat’s year-end occurrence wherein the vaginal opening of a health care know that they are not allowed countdown of the Top 10 stories that rocked woman closes. Anonymous people claimed to divulge information about patients’ the Department of Health in 2010, based on that John Lloyd Cruz and Shaina were having conditions. The rumor is putting in a bad media monitoring of health news coupled sex in the latter’s house. At the climax of their light the country’s hospitals, doctors and with the opinions of the editorial staff. tryst, Shaina’s vaginal opening apparently others in the field. locked while John Lloyd’s genital was inside 10 it. The two allegedly tried to remedy the 9 situation but to no avail. What they did was BAD to cover themselves with a blanket and rush Justice for “Locked” to the St. Luke’s Medical Center. As the story “FLORENCE” spread, it grew. One comment alleged that Showbiz and health news crossed his/her friend’s doctor friend at the said It is not easy for government to paths again this year, making it in our Top 10 hospital confirmed that it indeed happened. attract medical and health workers to serve list. Last year it was Dr. Hayden Kho, Jr’s sex ABS-CBN and Star Magic, the the rural and far-flung communities, and videos in our countdown, now it is the nasty couple’s home network and manager, when something bad happens to one of the rumor in August about a showbiz couple refuted the rumor several times, calling it “a very few volunteers who heeded the call, allegedly being “stuck” together and rushed hoax and the work of the sick minds.” the more it becomes problematic to sustain to one of the country’s premiere hospitals. For the health and medical field, the efforts on health service delivery in It started out as a blind item and this rumor is not just sick, it is also damaging many parts of the country where people are

LEFT: Shaina Magdayao and John Lloyd Cruz caught in a nasty showbiz rumor this year. (Photo grabbed from ) RIGHT: A protest placard shouting “Justice for Florence” to show support for a volunteer nurse who was allegedly gang raped in Maguindanao on September 25. (Photo grabbed from Yahoo! Philippines.)

November - December 2010 I HEALTHbeat 39 needing health care the most. Fulgencio. the angle of rebellion with the arrest of 43 The rape of “Florence” near her As the story developed, the Philip- health workers (17 men and 26 women) work place in South Upi, Maguindanao pine Nurses Association (PNA) remained believed to be members of the New People’s on September 25 brought issues of safety vigilant in the progress of the case and it Army, while holding an assembly at a house over service. “Florence,” a 21-year old nurse coordinated with the Justice Department in Maybangcal Village in Morong, Rizal. is a volunteer nurse working under the in fine-tuning the group’s legal moves on An Army spokesperson said the 43 government’s Nurses Assistance for Rural the matter. Teresita Barcelo, PNA president, health workers (which is now known as the Services (NARS) Program. According to police expressed fears that in the end, no one will Morong 43) were arrested by a combined reports she and her co-nurses had a night be jailed because there is an unseen hand team of local police and Army troops for out at a local videoke bar before the sexual muddling the case and confusing the facts. allegedly conducting explosives training in assault against her happened. At about 10 “Florence” suffered trauma a private residence owned by Dr. Melecia p.m., the group called it a night and parted and partial paralysis, but is now in stable Velmonte. ways. “Florence” was found barely conscious condition and recovering. Immediately after the arrest, the next morning in a grassy area at the back health workers from the Health Alliance for of the hospital where she worked. 8 Democracy (HEAD) condemned the raid and Police initially arrested the six said that those arrested were community suspects after witnesses reportedly saw FREE health workers conducting a health skills them with the rape victim in a videoke bar training in Velmonte’s residence. HEAD before the alleged gang-rape. The six were Morong 43 added that Velmonte is a “renowned and also reportedly among those who found the respected infectious disease specialist and volunteer nurse naked and unconscious in Community health service took her farmhouse is the regular venue of health a cornfield and brought her to the hospital, training, with participants coming from both while one of them reported the incident to Gary Liberal (right) is one of the 43 health workers arrested by the military on February 6, 2010 on the communities and the academe.” the local police. suspicion of being New People’s Army rebels. Liberal The health workers are facing South Upi Vice Mayor Jordan is an operating room head nurse and Union president charges of illegal possession of firearms and Ibrahim was also invited for questioning by of the Dr. Jose R. Reyes Memorial Medical Center. He is explosives. Five of them have been placed the police for his alleged involvement in the also a member of the Alliance of Health Workers. (Photo under separate military custody at Camp grabbed from freethehealthworkers.blogspot.com) crime, because he came to the police station Capinpin in Tanay, Rizal after they allegedly asking about the rape incident. He was admitted they were NPA supporters, while asked to give a specimen sample for forensic the remaining 38 were transferred last investigation, but he refused and reasoned May to the Philippine National Police (PNP) that he was not a suspect. Then, Melchor Custodial Center in Camp Crame in Quezon Fulgencio, a former member of the Citizen City. Armed Forces Geographical Unit (CAFGU) In October, an open letter to the came out and signed a sworn statement that President, signed by officers of international he and a certain Edwin committed the crime. and local organizations coming from various He recanted his statement later, saying he sectors, urged President Benigno S. Aquino was tortured by his neighbors into admitting III to release the 43 health workers, put an to the crime. end to their persecution, and to continue the Meanwhile, the Maguindanao struggle for the people’s right to health. prosecutor’s office cleared the six men The open letter stated, “Two of involvement in the crime citing lack doctors, a nurse and two midwives together of sufficient evidence against them. On with 38 community health workers were the other hand, the prosecutor’s office undergoing a First Responders’ Health recommended the filing of charges against training when they were arrested by the

40 HEALTHbeat I November - December 2010 military through the use of a defective search warrant. They were held incommunicado for several days, tortured and deprived of their right to counsel. They were falsely accused of undergoing a “bomb-making” training.” “The arrest of the 43 puts to risks health professionals and volunteer community health workers who serve the poor especially in far-flung areas of the country,” the letter continued. “For health professionals who may be considering the option of public service in the countryside, the incident is terrifying. For it is not only material comfort that one will be giving up when one chooses the selfless path of service to the poor, but possibly one’s life, as well.” On October 14, President Aquino Forty-one people, including five foreigners, were killed when a packed bus plunged into a deep ravine in Benguet Province on August 18. This is one of the many bus accidents that occured this year. (Photo said he will leave the Morong 43’s release grabbed from Inquirer.net) up to the courts, in effect rejecting calls for him to grant freedom to the detained health The string of bus accidents started immediately surrendered to the police and workers as he recently did to some 300 on June 13 when a bus carrying around 50 told investigators he lost control of the bus soldiers accused of various rebellious acts. passengers, mostly Iranian nationals who after it developed a mechanical problem. “Hindi naman puwede iutos ng executive na were post-graduate students of Gullas And on August 28, four people lumaya sila without the court’s sanction (The College and Cebu Doctors Hospital, fell some were killed and 32 others were hurt when a executive cannot just order their release 30 meters into a ravine at Trans Central Manila-bound passenger bus from Tacloban without the court’s sanction),” said the Highway in Balamban, Cebu. The brakes City accidentally fell into the Hamaw river President. apparently failed and 21 of the passengers 30 feet below the Maharlika highway in were killed. Then on July 3, again in Cebu, Pagbilao, Quezon. According to survivors, the 7 15 people were killed and 48 people were bus had already lost its brakes when it was injured after the brakes on a speeding bus descending the zigzag road. This accident Rolling packed with passengers failed and the was not the last in the remaining months of COFFINS vehicle slammed into a concrete barrier in 2010. Toledo City. The Land Transportation Office The biggest story in the country in On August 18, a family of four (LTO) said that 57 percent of the over 20,000 2010 might be the tourist bus hostage siege Americans of Filipino descent who were vehicular accidents that occurred nationwide in which sacked Manila policeman Rolando visiting their old hometown were among in 2009 was due to human error, thus, the Mendoza killed eight Hong Kong nationals the 41 people killed after the vehicle’s brakes need for a more aggressive driver and road on August 23. But that is more of a police failed on a mountain road in Naguilian Road safety education. and foreign affairs matter than a health in Barangay Banangan, Sablan, Benguet. Out of the said percentage of concern. But it is just one of the many big Four days later, on August 22, a Filipino- accidents caused by human error, 45.8 stories involving buses that claimed lives German beauty queen who represented the percent of the vehicular accidents are due to and caused injuries to people that happened country in the Miss International 2009 and bad turning, bad driving, and over speeding, in succession in June to August. Because of her two companions were killed after the van 3.7 percent is due to drank driving, 2.4 percent these accidents, buses are already being they were riding was struck by a passenger is caused by drivers using cellular phones, coined as “rolling coffins.” bus in Bula, Camarines Sur. The bus driver and 5.3 percent are hit-and-run incidents.

November - December 2010 I HEALTHbeat 41 The 2009 figures for vehicular accidents is approach that addresses vehicles, the people in marketing of dietary supplements. In a 25 percent increase compared to the over who use roads, and the road infrastructure, addition, companies can also claim that 16,000 vehicular accidents recorded by roads can be made safer. their product addresses a nutrient deficiency various law enforcement agencies in 2008. in the body. The use of the disclaimer “No Meanwhile, the Metro Manila 6 Approved Therapeutic Claim” is also being Development Authority said that in Metro abused by various owners, advertisers and Manila, where more than 6,000 passenger NO APPROVED agents of food/dietary supplements. Thus, buses ply the roads, 10 bus accidents there is a growing public concern due to the occurred every day in 2009 and at least one Therapeutic Claim inaccurate, misleading and false claims on in 10 incidents resulted in deaths or injuries, the efficacy of some of the supplements that while most resulted in damaged vehicles. In the Philippines, manufacturers are in the market today. In an ANC public affairs program of supplements do not need to seek approval In March, the Department of Health in September, Johnny Angeles, vice- from the Food and Drug Administration issued Administrative Order (AO) 2010-0008 president of the Automobile Association to provide directives specific to the change in of the Philippines (AAP) and the use of the message or phrase chairman of its Road Safety “NO APPROVED THERAPEUTIC Committee, said the condition of CLAIM” in all advertisement, the vehicle, the human factor and promotion and/or sponsorship the environment–which includes activities or materials concerning the condition of the road and the Food/Dietary Supplements with weather– contribute to the risk. the end view of promoting and “We can’t do so much about the protecting the consumers’ health road, he said, “it’s government’s and welfare and fostering their job to make the roads safe.” right to proper information and Meanwhile, an in-depth education to facilitate sound report of Marya Salamat published choice. in bulatlat.com in October, said According to then Health that “The public and government Secretary Esperanza Cabral, the officials, among them President DOH is duty bound to protect the Aquino, always blame drivers general public from any false each time a deadly bus accident information. She said that the happens. What they don’t know use of the message or phrase “No — or chose to ignore– is that bus Approved Therapeutic Claim” shall drivers and conductors are working no longer be allowed; instead all under severe conditions imposed food/dietary supplement owners, by greedy operators and ignored manufacturers, distributors, by government regulators, thus importers, exporters, advertisers allowing these mishaps to happen and/or their agents are obligated in the first place.” to strictly enforce the standard The World Health message in Filipino which will Organization, on the other hand, be “MAHALAGANG PAALALA: stated that loss and suffering ANG (name of product) AY HINDI associated with road traffic deaths GAMOT AT HINDI DAPAT GAMITING and injuries are preventable. With PANGGAMOT SA ANUMANG URI NG firm political will and an integrated DOH print advertisement published in June. SAKIT. “This is an essential step in

42 HEALTHbeat I November - December 2010 who are self-employed individuals like farmers and fisherfolks and even the daily wage earners such as vendors and transport drivers and operators, and the self-practicing professionals, and enroll poor families identified by the Department of Social Welfare and Development through the National Household Targeting System. During the SONA , P-Noy said that different data on PhilHealth coverage was available. He said, “Sabi ng PhilHealth sa isang bibig, 87 porsyento na raw ang mayroong coverage. Sa kabilang bibig naman, 53 porsyento naman. Ayon naman sa National Statistics Office, 38 porsyento ang may coverage.” In response to the President’s call to look at PhilHealth coverage, PhilHealth has organized an interagency technical working President Noynoy Aquino and Health Secretary Enrique Ona distribute PhilHealth cards at the launching of PhiHealth Sabado in Baseco, Tondo, Manila on October 2. (Photo by Paking Repelente) group (TWG) to identify and address issues related to differences in reports on PhilHealth protecting our people who may erroneously the wealth of the multinationals prevailing membership coverage. In the absence mistake these products as medicines,” she over the health of the people? of complete enumeration of PhilHealth added. beneficiaries (PhilHealth principal member Because of this strong and forceful 5 plus dependents), one of the first tasks of translation in Filipino language, herbal the TWG was to identify the methodology companies, particularly the Chamber of UNIVERSAL that provided the best estimate of PhilHealth Herbal Industries of the Philippines, Inc. Health Care coverage. (CHIPI), protested the implementation of However, enrollment of Filipinos the AO. They claimed that no consultation Consistent with President Benigno is only the first step towards “financial was made and that due process was not S. Aquino III’s commitments on universal risk protection” or the ultimate effect of upheld in the implementation of the AO. health care articulated in his inaugural health financing scheme that eliminates They brought the case to court. speech, “Serbisyong pangkalusugan, tulad if not greatly reduces the out-of-pocket On May 28, Judge Lilia Purugganan ng PhilHealth para sa lahat sa loob ng tatlong patients pay for health care. The PhilHealth of the Manila Regional Trial Court (MTC) taon,” and his first State of the Nation benefit delivery review conducted by the Branch 30, issued a preliminary injunction Address, “Para mabigyan ng PhilHealth ang Health Policy Development Project using granting the request of the CHIPI. According limang milyong pinakamaralitang pamilyang PhilHealth data of 2008 estimates that the to Purugganan, the new mandatory label Pilipino,” the Department of Health led average benefit delivery rate nationwide will condition the minds of the people that the conduct of a nationwide PhilHealth of the National Health Insurance Program CHIPI’s products are of no value at all. The Registration Day on October 2. is around 8 percent. This means that the court also stated that “there is the danger of Dubbed as “PhilHealth Sabado,” cumulative likelihood that any Filipino: a) erosion of confidence of the public towards the campaign aimed to increasing is eligible to claim PhilHealth benefits; b) food/dietary supplements on the account of public awareness regarding PhilHealth knows entitlements, able to access and avail the misconception or the misperception that entitlements and responsibilities, enjoin health services from accredited providers; the AO will produce.” Is this another case of enrollment of the informal sector or those and c) whose total health care expenditures

November - December 2010 I HEALTHbeat 43 are fully reimbursed by PhilHealth is only Noy administration, universal health care of the Catholic Church’s strong opposition is 8%. means the availability and accessibility of again being made into a priority bill in the Moreover, another study shows essential health services, basic necessities new Congress. In September during his visit that even those who already have a and appropriate quality health care for all to the US, President Noynoy Aquino may PhilHealth card do not use it when they access Filipinos. This entails adequate resources, in have inadvertently stirred the hornet’s nest health care. A recent study entitled “Review terms of health human resources, healthcare when he told a The Filipino Channel (TFC)- of Private Hospitals in the Philippines” by facilities, medicines, and health financing. organized town hall meeting in San Francisco the Philippine Institute for Development that “government might provide assistance Studies shows that among those who were 4 to those without means if they want to confined to hospitals, only 51 percent of Go Out & employ a particular method.” And the RH those admitted in private hospitals used debates this year took epic, melodramatic, their PhilHealth during their confinement MULTIPLY soap-operatic proportions wherein people while less than a quarter (24 percent) of are expected to “abangan ang susunod na those admitted in public facilities have used D E B A T E S kabanata” (watch out for the next episode). their PhilHealth. Fetuses are dumped everywhere Just to give a sort of flashback: Health Secretary Enrique T. Ona – in Church yards, creeks, bay areas, and a retired Catholic bishop threatened civil pointed out that “It is very important that we dumpsites. A female overseas Filipino disobedience by the public as well as do not just enroll the poor families or enjoin worker left her newborn baby in the toilet excommunication or the very least voluntarily the informal sector to enroll to PhilHealth, of an international plane on her flight back not receive Holy Communion to those who it is also very important that we tell them to the country. There are now over 92 million will support the bill; a popular tourist guide, their entitlements and their responsibilities Filipinos, according to the National Staistics clad in a national hero costume, protested of being a PhilHealth member.” Office, making the Philippines the 12th most in front of the main altar of the Manila The path towards universal health populous nation in the world. But trashing Cathedral holding a placard with the word care does not start or end with PhilHealth dead fetuses and leaving live newborns “Damaso,” referring to the hated Spanish Sabado last October 2. This event instead in airplanes are not means of curbing the friar in Jose Rizal’s novel Noli Me Tangere, provided an impetus that will propel population growth. and telling the Church to “stop involving the health sector in achieving its goal The Reproductive Health (RH) yourselves in politics!”; and the exchanges of providing equitable and sustainable Bill which has languished in both houses of of opinions of members of the “pro-life” and financing for health care. In fact, for the P- Congress for the past 14 years largely because “pro-choice” organizations. In October, there was a moment of ceasfire as the government and the Catholic Church held a dialogue. The Church opposed the RH Bill and the distribution of contraceptives. President Aquino, on the other hand, said the choice of family planning method is better left to parents, with the state ready to assist those who prefer artificial ways but has no means to avail of these. And the debate was brought back into the halls of Congress. House Minority Floor Leader and Albay Representative Edcel Lagman and Senator Miriam Defensor-Santiago are pushing RH Health Secretary Enrique T. Ona and House Minority Floor Leader and Albay Representative Edcel in Congress and Senate, respectively. In the Lagman meet at the World Population Day event on July 12. (Photo by Paking Repelente) this kind of an issue, several legislators chose

44 HEALTHbeat I November - December 2010 to keep their silence and avoided their usual grandstanding. A report by Ana Mae G. Roa of Business World Online enumerated the salient features of the RH Bill other that the use of contraceptives which the Church has isolated in the discussions and debates. The bill also features the strengthening the Population Commission, provision of skilled midwives in every city and municipality to achieve a ABOVE: Former Health Secre- minimum ratio of one midwife for every 150 tary Esperanza Cabral (fourth from right) with tobacco control deliveries per year, emergency obstetric care advocates from different for each province and city, maternal death organizations during the press review based on guidelines to be issued by conference on May 24 for the the Department of Health in consultation issuance of Administrative with the Population Commission, hospital- Order 2010-0013 on putting graphic health information on based family planning, mobile health care tobacco products. (Photo by service per congressional district, and age- Paking Repelente) appropriate RH education. Also provided for are certificate BELOW: Under the said Order, of compliance from the family planning the cigarette pack would look this way. office that couple has received adequate instruction and information on family many challenges occuring along the way. on tobacco product packages. planning, responsible parenthood, breast- Tobacco control issues have made it to the The DOH is merely implementing feeding and infant nutrition before the Top 3 list of the most talked about health Article 11 on Packaging and Labeling of the local civil registrar issues a marriage license; issues in the country, ranging from the call of Framework Convention on Tobacco Control capability building of community-based various groups for President Noynoy Aquino (FCTC), an international health treaty, that volunteer workers on delivery of RH services; to quit his smoking habit to the Civil Service mandated all member parties to implement attaining a non-mandatory, non-compulsory Commission’s policy to restrict smoking in the same through “all legislative, executive, ideal family size; nondiscrimination on government offices, to the moves of the Land administrative or other issuances as would hiring, regularization and employment Transportation and Franchising Regulatory best carry out the treaty within a period of of women or selection for retrenchment; Board’s order for a 100% smokefree public three years from the time a member Party support of private and nongovernmental utility vehicles and land transportation has ratified or acceded to the Convention.” The health care service provider; and sustained terminals as well as the Department of Philippines ratified the FCTC on September public awareness campaign on RH. Education and the Commission on Higher 4, 2005 and by 4 September 4, 2008, the Education’s memoranda for smokefree country should have complied with Article 3 schools. More and more local government 11 minimum standards. units nationwide are also passing smokefree Before the 90-day grace period for Pakita ang ordinances in their areas. the full implementation of the AO, tobacco TOTOO On May 24, the then Health companies have filed cases against the DOH Secretary Esperanza Cabral issued in different courts – Fortune Tobacco in sa Pakete Administrative Order (AO) 2010-0013 Marikina City; Philip Morris-Fortune Tobacco requiring graphic health information and Corporation in Tanauan City, Batangas; Tobacco control advocates have the removal of misleading descriptors such Mighty Corporation in Malolos, Bulacan; a reason to celebrate this year despite the as “mild,” “light,” “ultra-light” and “low tar” La Suerte Cigar and Cigarette Factory in

November - December 2010 I HEALTHbeat 45 Paranaque; and Japan Tobacco Corporation in Pasig City. Jose 2 cited Fortune Tobacco Corporation which filed a case in Marikina City R i s i n g and Mighty Corporation Tobacco Company which filed a case in HIV/AIDS Bulacan. HIV/AIDS news have not One of the arguments reached this big in HealthBeat’s of the tobacco industry is that countdown for quite some time, the country’s Tobacco Regulation until the end of January when Act of 2003 or Republic Act (RA)) media reported the results of 7394 which was passed two years a study entitled “Lifestyle and before the Philippines ratified Reproductive Health Issues of the FCTC, only called for written Young Professionals in Metro warnings. Thus, they say, DOH has Manila and Metro Cebu” conducted usurped the legislative function by the University of the Philippines of Congress if it requires graphic Population Institute and the health information as well. Department of Health. Of the five courts, the Call center agents were one in Marikina City and another particularly cited by the media in Bulacan have issued preliminary on the rise of HIV cases in the injunctions stopping the DOH Philippines. This is bad considering Order. A court in Parañaque City DOH HIV/AIDS youth advocates in Pateros (top) conduct one of their that business process outsourcing declared the Order null and void, community assemblies (bottom) to teach their peers about HIV/AIDS (BPO) has contributed a lot to the while a Pasig City court has yet to prevention and control. Their theme: “Sapat ba ang Sarap? Dapat economic progress of the country. Maingat!” (Photos courtesy of Vina Marie Cotin) rule on the matter. The biggest joint The study was conducted to venture corporation formed by Philip Morris Leo Battad and Jose Jose of the examine the economic, social, and health Philippines Manufacturing, Inc. and Fortune University of the Philippines Office of Legal status of young professionals less than 35 Tobacco in Tanauan City lost its case where Aid, counsel for the petitioners, argued that years old. It included 929 respondents from a court dismissed the petition against the Section 13(g) of the law did not curtail the 35 BPO establishments, who have at least DOH. right and duty of the DOH to issue regulations completed two years of college. However, On September 7, the tobacco protecting the right to health and health the Philippine National AIDS Council clarified control advocates made their own offensive information. that the study was done among employees move. Over a hundred petitioners led by For the DOH and other tobacco of BPO companies where a call center is just former senator and health secretary, Dr. Juan control advocates, tobacco smoking is an one of the many “business processes” that Flavier and running priest Fr. Robert Reyes addiction and it contains over 40 carcinogens they carry. want the Makati court to issue a “clarificatory and thousands other chemicals affecting not The study showed that due to judgment” on Section 13(g) of RA 7394 in only the smoker but those around them their environment and peer pressure, call relation to the DOH AO. The case was filed through secondhand and third-had smoke. center agents “tend to involve in risky sexual against the Philippine Tobacco Institute and The tobacco industry cannot be treated like behaviors.’’ The study also revealed there are six tobacco companies. any other company or business because it is more call center agents who have a regular Section 13 (g) of the RA 7394 imbued with a public health risk that needs non-romantic sexual partner. requires that no other printed warnings, to be regulated strictly and specifically to The DOH said that call center except the health warning and the message prevent the youth and the poor from being agents may be at risk of HIV due to their required shall be placed on cigarette packs. exploited or initiated to smoking. high risk behavior for lifestyle diseases

46 HEALTHbeat I November - December 2010 due to cigarette smoking, substance abuse Davao to educate their peers on HIV/AIDS (independent) film entitled “HIV - Si Heidi, alcohol and illicit drugs, poor nutrition, prevention and control. Si Ivy at si V” was premiered. It stars Jake and inadequate exercise and unsafe sexual By the end of September, DOH data Cuenca, Iza Calzado, Maria Isabel Lopez, practices. However, the DOH was quick to showed four to five people are reported with IC Mendoza, among others. It is directed point out that it is not safe to conclude that HIV daily in the Philippines. A total of 16% by Neal “Buboy” Ocampo from the script of the higher prevalence of sexual risk behavior of reported HIV cases have AIDS, and nine Wanggo Gallaga - an HIV positive. The DOH among call center workers can be attributed out of 10 HIV cases are transmitted through co-produced the film together with Exogain to working in the call centers. sexual contact. Majority (76%) of cases are Productions. (See related story on page 25.) The study has opened a Pandora’s males. Moreover, overseas Filipino workers box of issues surrounding HIV/AIDS, including remain to be affected with HIV. 1 the controversial DOH awareness campaign The youngest reported HIV case dubbed as “Ingat Lagi, My Valentine,” in is two years old who contracted the virus L I V I N G February when the giving out of condoms to through mother to child transmission. Some DENGUE adult customers at a popular flower market in 52 children, aged two to less than 15 years Manila was held. Adults who bought flowers old, were reported to be infected with HIV -rously were given brochures on AIDS prevention through mother to child transmission. and vouchers to be exchanged for condoms And in December, an indie 2010 is the year of living at designated booths. The condoms “dengue-rously.” Dengue did not were given for free by the condom make it in the Top 10 list of health distributor, DKT International. news last year, but it came back Meanwhile, children were given this year and zoomed to No. 1 as lollipop candies. cases have rose to an all-time high, The DOH insisted that peaking in August. The Department the condom distribution was of Health reported 98,934 dengue not intended to promote the use cases with 644 deaths (case of contraceptives but rather to fatality rate of 0.65) from January encourage couples to engage in 1 to September 25, 2010. This is a safer sex. Church leaders, however, huge surge compared with 57,819 condemned the DOH drive as cases were reported for the entire “immoral” and “vulgar”. They year in 2009. said that instead of preventing The World Health the spread of HIV/AIDS, the DOH Organization considered dengue is in effect promoting the sex as one of the fastest-emerging act. Education particularly on infections in the world. Among abstinence and not condom will the estimated 2.5 billion people help solve the problem on HIV/ at risk globally, more than 70% AIDS in the country, the Church reside in the Asia Pacific countries, leaders said. with the Lao People’s Democratic In other related stories, Republic, Malaysia, Viet Nam during the summer vacation, the and the Philippines among those DOH deployed volunteer HIV/AIDS particularly badly affected. advocates, composed mainly Children are most vulnerable to dengue, that is why many of the Dengue fever, a flu-like Department of Health’s dengue prevention and control activites are held of college students, who were in schools. TOP: Aedes mosquito mascot hides her face from Secretary illness spread by mosquitoes, assigned to communities in Metro Enrique T. Ona and DOH-Metro Manila Director Irma Asuncion. BOTTOM: often emerges when the insects Manila, Metro Cebu and Metro Sec. Ona with grade school children. (Photos by Paking Repelente) are able to breed in large numbers

November - December 2010 I HEALTHbeat 47 in locations exposed to still water such as and DEN-4) made things worse for public Ona said. containers, improperly managed garbage, health experts,” Tayag further explained. And in the light of rumors of the building sites and flower pots. The disease He added that if a person becomes infected medicinal value of the herb tawa-tawa, is particularly prevalent in substandard of DEN-1, he/she becomes immune to the durian fruit and other plants as a cure against housing areas with poor sanitation. DEN-1 strain but not to the three remaining dengue, health professionals maintained However, even the rich and famous are not strains. that there is still no evidence confirming exempted having the disease, just like Kris Meanwhile, Health Secretary such. Aquino’s sons, Joshua and Baby James, who Enrique T. Ona issued an order to all DOH The DOH reiterated that the most got dengue in 2009. This year, Kris involved hospitals to activate their dengue express effective way to prevent and fight dengue herself in dengue awareness activities, lanes to facilitate patient admission for is still by practicing the DOH’s 4-S strategy particularly in schools. severe dengue cases. He also announced consisting of Search and destroy, Self- There is currently no treatment the new D.E.N.G.U.E. strategy to educate the protective measures, Seek early treatment or vaccine for dengue. Early recognition public on home treatment of mild dengue and Say no to indiscriminate fogging. These and prompt supportive treatment can cases. This will aid in decongesting tertiary strategies must be done throughout the substantially lower the risk of developing hospitals by assuring the public that not all year because dengue is no longer a seasonal the severe disease. The principal symptoms dengue cases require hospital confinement (rainy season) disease in the country. of dengue fever are high fever, severe but can be managed at home using the said In a statement released in headache, severe pain behind the eyes, joint strategy. September, the WHO said that the increase pain, muscle and bone pain, rash, and mild “Instead of confining patients in a in dengue cases can be attributed to a bleeding (e.g., the nose or gums). However, hospital facility, parents and caregivers can number of factors. These included higher in severe cases, death from dengue shock practice the D.E.N.G.U.E. strategy. D.E.N.G.U.E. temperatures and rainfall in many parts of syndrome can occur in a minority of persons, stands for D - daily monitoring of patient’s the region this year, growing population especially if early treatment is not sought. status, E - encourage intake of oral fluids like densities, and greater international DOH Spokesperson, Dr. Eric Tayag oresol, water, juices, etc, N - note any dengue travel. Higher awareness levels and better said that the first episode of infection causes warning signs like persistent vomiting and surveillance systems were also probable the body to develop antibodies to a particular bleeding, G - give paracetamol for fever factors in some countries. type of strain. However, if infection occurs and NOT aspirin, because aspirin induces Even though there was no firm again, the antibodies may not be able to bleeding, U - use mosquito nets and E - early evidence yet that the increase in cases was neutralize the new strain, which may cause consultation is advised for any warning signs tied to global warming, climatic change plays the immune system to overreact resulting include severe abdominal pain or persistent an important role in the spatial and temporal in more severe and more virulent dengue vomiting, red spots or patches on the skin, distribution of dengue. Mosquitoes are now infection like dengue hemorrhagic fever or signs of bleeding, black stools, drowsiness being found in areas where they were once dengue shock syndrome. “The circulation of or decreased consciousness, difficulty of not common, including the Republic of Korea four dengue strains (DEN-1, DEN-2, DEN-3, breathing, and pale or cold clammy skin,” and the highlands of Papua New Guinea.

NOTE: Health news beyond November 10, 2010 are not included in this countdown. ERRATUM major major mistake In the Healthbeat July-October 2010 ‘s article on “Dealing with Dengue,” we inadvertently interchanged the contents of pages 27 and 29. Sorry about that.

48 HEALTHbeat I November - December 2010 TEST results

Answers to “Hulaan Mo Nalang” on Page 3

1. a) Dengue. 2010 is the year of living “dengue-rously.” Dengue zoomed breast cancer is now the leading cancer site overtaking lung cancer for both to No. 1 as cases have risen to an all-time high, peaking in August. The sexes in the Philippines (i.e. 15% of all cancers). It is estimated that there will Department of Health reported 98,934 dengue cases with 644 deathes (case be a total of 12, 262 new breast cancer cases in 2010 with 4,371 deaths. Data fatality rate of 0.65) from January 1 to September 25, 2010. This is a huge also reveal that three out of every 100 Filipinas are likely to develop breast surge compared with 57,819 cases were reported for the entire year in 2009. cancer in their lifetime and that one out of every 100 are likely to die from (See “Health News: Top 10 in 2010” on page 39.) the disease before age 75. (See “Piloting the Patient Navigation Program” on page 22.) 2. a) April and October. Garantisadong Pambata (GP) is an institutionalized national health campaign conducted every day in health facilities, but with 7. c) Schools. Republic Act 9211 or the Tobacco Regulation Act of 2003 special events every April and October where essential package of health does not allow smoking in centers of youth such as schools, playgrounds, services and health information are delivered to protect children and health and social welfare facilities. However, smoking in designated areas is promote positive behaviors to parents and caregivers. In October, GP is now allowed in public places such as bars, restaurants and other entertainment expanded to cover not only children 0-5 years old but also the 6-14 years old. venues. But evidence shows that separate smoking sections do not work. (See “Basta Kalusugan ng Bata, i-GP Mo!” on page 11.) Simply separating smokers and non-smokers within the same air space does not eliminate nor reduce exposure to secondhand smoke. (See “Take Your 3. a) Asia. According to the June 2010 report of the Internet World Breath Away” on page 18.) Statistics, conducted by the Miniwatts Marketing Group, there are around 1,966,514,816 internet users worldwide. This is a 444.8% growth rate from 8. c) shirt sleeve. The US Centers for Disease Control (CDC) recommends to the year 2000. Surprisingly, Asia has the biggest share of users among world turn your head to your shirt sleeve to cover your nose and mouth when you regions. (See “Log on to Computer Addiction” on page 14.) cough or sneeze. This is also called the “Dracula Approach” which is to sneeze and cough into your elbow, as if you are drawing up your arm in a cape. The 4. b) Trans Fat. Fats and oils are part of a healthy diet and major sources of fabric will absorb the germs from your cough or sneeze. (See “How Do You energy and aid the body in absorbing vitamins, but not all fats are the same. Cough and Sneeze?” on page 34.) Saturated and trans fats increase the risk of heart disease by increasing the total and LDL (“bad”) cholesterol. Saturated fats come from animal products 9. c) Vaginismus. It is a condition where there is involuntary tightness of the and coconut, palm and other tropical oils. Trans fat comes from partially vagina during attempted intercourse. Oftentimes, vaginismus is the culprit hydrogenated vegetable oils, commercial baked goods (such as crackers, in unconsummated marriages/relationships because it makes penetration cookies and cakes), fried foods (such as doughnuts and french fries), very difficult or impossible. Vaginal tightness can be so restrictive that shortening and margarine. (See “Healthier Food Choices GOOD FOR YOU” on the opening is ‘closed’ to allow penetration of the penis. For the meaning page 6.) of the other choices: clyamydia is a sexually transmitted infection while dyspareunia is genital pain associated with sexual intercourse. (Vaginal Lock: 5. b) Patch Test. In patch test, various chemicals are placed into small metal Is it Real and Is it Rare? on page 31.) cups affixed to paper tape and this is placed on the skin of the back for up to two days. This test shows whether a person develops contact dermatitis 10. a) Wanggo Gallaga. “HIV - Si Heidi, Si Ivy at si V” is the first Department (rash), which is an allergic reaction on the skin due to direct contact with an of Health’s co-produced indie (independent) film directed by Neal “Buboy” allergen such as latex, medications, or fragrances. (See “When Allergy Gets In Tan from the screenplay of Wanggo Gallaga, the son of a critically acclaimed the Way of Vanity” on page 35.) film director, Peque Gallaga. When Wanggo publicly announced in 2009 that he was HIV positive, it sent a powerful message that anyone can get HIV. (See 6. a) Breast Cancer. According to 2010 Philippine Cancer Facts and Estimates, ““HIV - Si Heidi, Si Ivy at si V” on page 25.)

What Your Scores Mean

10 You don’t need this magazine. Give it to someone and read something else! 7 - 9 Aha, you’re getting new information. After reading this magazine, pass it to a friend so that our readership may increase too. 4 - 6 Keep this magazine as a reference. You might need to browse and read it again. 1 - 3 You have to be more concerned about health. Start now by reading this magazine from cover to cover. Don’t miss the inside pages, okay? 0 What have you been doing lately? How about getting some English Reading and Comprehension classes? November - December 2010 I HEALTHbeat 49 SAbeat New Year’s Resolution Ngayong 2011 10 Most Powerful Women

DANNY: Lima lang ang New Year’s Ayon sa Forbes Magazine, ang 10 Resolution ko sa 2011... MOST POWERFUL WOMEN ay sina: 10. Oprah Winfrey 1. Di na ko mangangako, 9. Queen Elizabeth PROMISE! 8. Gretchen Barreto 2. Di na ko mag-iingles, 7. Kris Aquino NEVER AGAIN! 6. Nanay Mo 3. Di na ko iinom, CHEERS! 5. Sister Mo 4. Di na ako magsusugal, 4. Misis ng Brother Mo PUSTAHAN TAYO! 3. Misis Mo 5. At di na ko magsasalita ng tapos, Talamak Sa Alak 2. Biyenan Mo PERIOD. 1. Si Inday Sukdulan na ang galit ng Misis sa Mister Chinese Feng Shui niyang lasenggo... 3 Palatandaan ng Pagtanda

JENNY: Feng Shui Master, nagdadala po ROSE: Simula ngayon, ang labi na may • Tuhod na lang ang tumitigas. ba ng swerte ang paglalagay ng bahid ng alak ay hindi na • Balahibo nalang ang tumatayo. mirror? makakadampi pa sa labi ko! • Mukha nalang ang nagagalit. MASTER: Ay oo, iha. If mirror at the stairs, JOJO: (Tahimik na nag-iisip.) may akyat na swelte at grasya... ROSE: At ano naman ang iniisip mo Harapin Ang Problema JENNY: Eh, kung sa door po?!? diyan? MASTER: If mirror at the door, may JOJO: Iniisip ko lang kung ano talaga MAU: Kapag tayo na, magkasama na pasok na swelte at grasya! Pero, ang mas gusto ko – ang 15-year nating haharapin ang mga may isa pinakaswelte sa mirror... old brandy o ang 50 years old na problema. JENNY: Talaga po, saan?!? labi mo! DIANE: Pero wala naman akong MASTER: If mirror sa ceiling, ikaw ay problema. pinakaswelte dahil nasa loob ka Lulubog Ang Barko MAU: Kasi nga, hindi pa tayo. ‘Wag ka motel! ngang excited dyan. JUSTIN: ‘Tay! Nag-aalala po ako. Ang lakas So What?!? ng bagyo at parang lulubog itong Government Project barko. Gumegewang-gewang sa daan ang isang NONG: Bakit ka mag-aalala, eh FRANCIS: Itay, ano po kayang magandang lasing, at napahinto siya sa ilalim ng hindi naman atin itong barko! gawin ko, kasi yung panty isang malaking billboard na nagsasabing: ng asawa ko ay may tatak na “ALCOHOL KILLS SLOWLY.” NO ENTRY? NITO: Easy lang anak, yung brief mo JOEREM: (Sinisigawan ang billboard) “So markahan mo ng GOVERNMENT what?!? Sino ba nagmamadali?” PROJECT - DO NOT DELAY. (-: Jokes and photo from the Internet :-)

50 HEALTHbeat I November - December 2010