10 contents 5 DOH ISO Journey Comes Full Circle 8 SONA on Health 10 Rotavirus Vaccine 12 Enterovirus 71 (Hand, Foot and Mouth Disease) 13 The Z-Benefit Package 16 Access DOH 20 From Personal Gains to Advocate 21 Postpartum Contraception 22 Interactive Komiks: Educating A New Breed 23 Ikaw at Ako ay Tayo 34 Inequalities in Non-Communicable Diseases 16 38 National Tobacco Control Strategy 39 Belly Big? Belly Bad! 42 Beware of Untreatable Gonnorhea 39 44 Islamic View on Vaccination 46 Red July in Central Luzon 47 The Need for SPEED 48 Batangas TREAT jokes 23 n'yo laughter HEALS 15 47 stress RELIEF 33 KALAbeat 41 FACEbeat 45 SAbeat 50 DEPARTMENT OF HEALTH - National Center for Health Promotion 2F Bldg. 18, San Lazaro Compound, Sta. Cruz, Manila 1003, Philippines HEALTHbeat Tel. No. (63-2) 743-8438 Email: [email protected] Request for Action
There are two things to define our success in life: 1) The way we manage when we have nothing; and 2) The way we behave when we have everything. The Department of Health rank-and-file employees have dedicated a lot of their time and effort to fulfill somebody's wish for this agency to be ISO-certified, even if it meant working overtime and on weekends polishing its systems and cleaning its processes to achieve quality management. Although many staff found it very hard to comply with the requirements, they saw the importance of the ISO in increasing their work efficiency. They hope that the top people in the organization would have a heart to provide their needs too. The hazard pay, a monthly cash benefit under the Magna Carta for Health Workers, has not been given for seven months and counting. Management now tells health workers that they are working on some guidelines on how the hazard pay would be provided. Editorial Board A classification scheme – high-risk, low-risk, and no-risk – is rumored to be the basis of Ivanhoe C. Escartin, MD giving the hazard pay. But then in the last Friday of July, a hospital's staff received their Rosemarie G. Aguirre hazard pay, leaving the Central and Regional Offices employees wanting. As if they were not Editors-in Chief Anthony R. Roda exposed to work-related hazards, from monitoring and advocating field implementation of May Elenor R. de Guzman health programs to stress from seemingly impossible bosses who keep on bragging that the Managing Editor Donato Dennis B. Magat prevention and control of non-communicable diseases is a priority of this administration. Staff Writers Elizabeth G. Mascareňas No DOH Central and Regional rank-and-file employee has P80 million declared in their SALN Glen S. Ramos (Statement of Assets, Liabilities and Net Worth). Some may have P80 thousand in their Cover Design Diosdado G. Angeles, Jr. savings account, but they hope that it could be more. Many who only have P80 in their wallet Graphics Design Joerem P. Ceria are trying very hard to make ends meet for the day. And some leaders still choose to be selfish in taking the hazard pay away from these health workers. Are they truly lifting the burdens of Photographer Paquito P. Repelente the poor or are they creating more poor? Contributors (Words) Rowena M. Bunoan And so what's next? In the pursuit of the DOH ISO Certification, issuing a "request for action" Leni P. Carreon Rhoderic N. Domingo or "RFA" is fast becoming a management tool for corrective or preventive action if a certain John Juliard Go, MD work process has been found not implemented or if a client/customer has been dissatisfied Valerie Gilbert T. Ulep, MD with a product or service. The rank-and-file employees could only wish that they could also Tato M. Usman, MD issue the same RFA to management for the release of their hazard pay. (Photo) Frederick C. Pereňa To quote Secretary Enrique T. Ona's battlecry at the start of the ISO journey in March last year, (Illustration) Antonio Totto, Jr. "Kaya natin 'to!" Circulation DOH-NCHP Production, Dissemination - The Editors and Collection Unit
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4 HEALTHbeat I July - August 2012 QUALITY management
Health Secretary Enrique T. Ona (sixth from left) receives the Certificate of Registration for operating a quality management system which has been assessed as conforming to ISO 9001:2008 in behalf of the 17 bureaus, centers and services of the Department of Health Central Office as well as the Centers for Health Development in Metro Manila and CaLaBaRZon. Renato V. Navarette, managing director of the Certification International Philippines, Inc. and Magdalena Mendoza, senior vice president, together with Arnel Abanto of the Development Academy of the Philippines (from fifth to third from left) officiate the awarding. Also in photo are DOH Executive Committee members and regional directors of Metro Manila and CaLaBaRZon. (Photo by Paking Repelente) DOH ISO Journey Comes Full Circle by ANTHONY R. RODA, MaHeSoS HEALTHbeat Staff
By mid-July, the Department of With this, the DOH has officially set Philippines (DAP), in his written message, Health ISO journey comes to a full stop when the record as the first government agency called the DOH’s feat as “Super QMS” because the Certification International Philippines to have a department-wide ISO quality of its huge scope covering five core processes (CIP), Inc. announced that it has approved management. The DOH – with its 17 bureaus, and 19 offices. He said, "This international to grant the Certificate of Registration to the centers and services inside the Central Office recognition is undoubtedly the result of the DOH for operating a quality management compound and the two pilot Centers for collective effort and hard work of everybody. system (QMS) which has been assessed Health Development (CHDs or regional You all deserve to be congratulated and as conforming to ISO 9001:2008. The CIP offices) in Metro Manila and CaLaBaRZon – commended for this success. I believe that said that the validity of the certificate is is now the biggest organization, both public the other line agencies look up to you even dated July 17, 2012 and they were already and private, to be certified. more and highly envy this recognition." preparing the award letter and certificate for Antonio D. Kalaw Jr., president And the "victory day" came. Health formal issuance the following week. of the Development Academy of the Secretary Enrique T. Ona received the ISO
July - August 2012 I HEALTHbeat 5 Certification from the CIP during provide technological, economic its regular flag raising ceremony ISO 9001:2008 CERTIFIED and societal benefits. on July 23. CIP is an affiliate of ISO 9001:2008 is the standard a British company Certification DOH-Central Office that provides quality management International U.K. Ltd., and since Bureau of Health Facilities and Services system or QMS regardless of what its operations in the Philippines Bureau of International Health Development the organization does, its size, in 1995 has certified more than Bureau of Local Health Development or whether it is private or public 900 Philippine and multinational Health Emergency Management Staff sector. QMS is deemed important companies who are leaders in Health Policy Development and Planning Bureau in government as it promotes their respective industry or service National Center for Disease Prevention and Control integrity, accountability, proper sectors. National Center for Health Facilities Development management of public affairs Renato V. Navarette, CIP National Center for Health Promotion and public property as well as managing director and Magdalena National Center for Pharmaceutical Access and Management establishes effective practices Mendoza, DAP senior vice National Epidemiology Center aimed at the prevention of graft president, officiated the awarding Philippine Blood Center and corruption. of the ISO Certification to the DOH. Administrative Service QMS in government agencies The DOH engaged the technical Finance Service and personnel creates conditions assistance expertise of the DAP in Human Health Resource Development Bureau that will transform them into developing a quality management Information Management Service professional, motivated and system for the department. Legal Service energized bureaucracies with Meanwhile, Assistant Procurement Service adequate means to perform their Secretary Gerardo V. Bayugo, the public service. DOH overall quality management DOH-Regional Office The scope of the DOH QMS for representative, congratulated and Center for Health Development - Metro Manila health systems administration thanked all the DOH employees Center for Health Development - CaLaBaRZon includes: health policies, involved in the process of achieving programs, systems and standards this milestone of the department. development; health research He said that all the remaining 14 regional Greek "isos," meaning "equal," which is the management; capacity building; health offices will also be certified next year. root for the prefix "Iso-" that occurs in a regulation; and health program monitoring host of terms, such as "isometric" (of equal and evaluation. ISO 9001:2008 measure or dimensions) and "isotomy" (equality of laws, or of people before the The DOH ISO Journey ISO is short for International law.) The name ISO is used around the world Organization for Standardization, the to denote the organization, thus avoiding The DOH ISO journey began on world's largest developer and publisher of the assortment of abbreviations that would March 14, 2011 when Sec. Ona led a simple international standards. Founded in 1947, result from the translation of "International ceremony and parade inside the Central ISO is a network of the national standards Organization for Standardization" into the Office compound which signified the start institutes of 159 countries, one member per different national languages of members. of the 12 steps of the ISO-QMS roadmap. country, with a Central Secretariat in Geneva, Whatever the country, the short form of the (See illustration next page.) The health chief Switzerland, that coordinates the system. organization's name is always ISO. said with much enthusiasm and conviction, ISO is a non-governmental organization Standards ensure desirable ”Kaya natin ‘to!” that forms a bridge between the public and characteristics of products and services such The QMS institutionalization private sectors. as quality, environmental friendliness, safety, phase happened from April to August 2011. According to ISO, "ISO" is not an reliability, efficiency and interchageability This involved the establishment of DOH ISO abbreviation. It is a word, derived from the and at an economical cost. ISO standards QMS Committee; engagement of the DAP
6 HEALTHbeat I July - August 2012 to provide technical assistance; awareness On September 19, 2011, the To spice things up and elicit building among DOH officials and rank- DOH Central Office and two pilot CHDs everybody’s support, cooperation and and-file staff, including the contractuals; started the implementation of its QMS commitment at this grand launch, each capability building of the quality after completion and approval of the basic participating office was asked to develop management representatives, comprising documentation. and present creatively a "tagline" or slogan of the director/s, division chiefs and ISO core On January 30 this year, the grand for ISO implementation. The winners of the team of each office; and the establishment launch of the ISO implementation was held. tagline and the presentation were awarded of DOH QMS documentation – Quality Policy, ASec. Bayugo said, "Now, looking at what with cash prizes. The Bureau of International Quality Manual, Quality Procedure and we have accomplished, we can all say 'Abot Health Cooperation's tagline, "ISO TAYO: Quality Core Procedures. Kamay Natin ang DOH ISO Certification.'" Serbisyong Dekalidad at SiguraDOH" won, while the Administrative Service won the presentation. The ISO-QMS Roadmap At this time, only four steps in the ISO roadmap were needed to achieve until April – management review, final gap assessment, preparation for certification, and finally, third party certification audit. Starting in April, three audit procedures were made to prepare for ISO Certification, namely pre-audit conducted by the DOH internal auditor and two stages of external audit by CIP. Each audit process identified non-compliance or opportunities for improvement, root cause analysis of the problem/s, and submission of improvement plans. ISO Certification would only be granted when all these requirements were met. And after all this long and difficult journey which was exciting, challenging and fulfilling, the much coveted ISO Certification was finally achieved. All praises to everyone. The DOH ISO Certification is valid until July 16, 2015 subject to adherence to the agreed audit program and compliance with Certification International regulations. Bayugo is once again urging the commitment of the DOH employees to continuously improve, meet, and even exceed people's expectations of a quality management system that enhances health care service delivery. Now, the DOH ISO journey comes Bureau of International Health Cooperation's winning tagline during the ISO implementation launch in full circle in order to maintain and sustain on January 30. its wonderful ISO 9001:2008 certification.
July - August 2012 I HEALTHbeat 7 KALUSUGAN pangkalahatan SONA on Health Excerpts from the English Translation of the Third State of the Nation Address (SONA) of H.E. President BENIGNO S. AQUINO III posted at the Official Gazette
This is my third SONA. It wasn’t too The process for our poorest long ago when we began to dream again; PhilHealth members: Enter any government when, united, we chose the straight and hospital. Show you PhilHealth card. Get righteous path.... In 2010, an estimated 36 treatment. And they return to their homes million Filipinos were still not members of without having to shell out a single centavo. PhilHealth. Forty-two (42) billion pesos was One of the briefings I attended noted that needed to enroll them.... four out of ten Filipinos have never seen a But what we know about our health professional in their entire lifetime. people, and what we had proven time and Other figures are more dire: Six out of ten again to the world was this: Nothing is Filipinos die without being attended to by impossible to a united Filipino nation. It health professionals. was change we dreamed of, and change we But whatever the basis, the achieved; the benefits of change are now par number of Filipinos with no access to for the course. Roads are straight and level, government health services remains a and properly paved.... concern. And we are acting on this: In 2010, President's Third SONA on July 23. And we are building an ten thousand nurses and midwives were environment where progress can be felt by When we first took office, only deployed under the RNHeals Program; to the majority. When we began office, there 62 percent of Filipinos were enrolled in date, we have deployed 30,801. Add to this were 760,357 household-beneficiaries of PhilHealth. Enrollment was not necessarily over 11,000 Community Health Teams tasked the Pantawid Pamilyang Pilipino Program. based on need but on being in the good to strengthen the links between doctors and Our target: 3.1 million within two years. By graces of politicians. Now, 85 percent of our nurses, and the communities they serve. February of this year, the three millionth citizens are members. This means that since And today, because of efficient household-beneficiary of Pantawid Pamilya we received our mandate, 23.31 million targeting, they are deployed to where they had been registered. Next year, we will more Filipinos have access to PhilHealth’s are most needed: to areas that have been enroll 3.8 million households—five times array of benefits and services. for so long left in the margins of society. what we had at the beginning of our term. And here’s even better news: the We have sent our health professionals to This is a long-term project, 5.2 million poorest households identified 1,021 localities covered by the Pantawid with far-reaching impact. The research by our National Household Targeting System Pamilya, and to the 609 poorest cities and is in its initial stages, but already the will now fully benefit from PhilHealth’s municipalities, as identified by the National figures show promise. Based on data from programs, free of charge. Because of the Anti-Poverty Commission. the Department of Social Welfare and Department of Health’s No Balance Billing This new system addresses two Development: 1,672,977 mothers now get Policy, treatment for dengue, pneumonia, issues: thousands of nurses and midwives regular checkups; 1,672,814 children have asthma, cataracts—as well as treatments now have jobs and an opportunity to gain been vaccinated against diarrhea, polio, for catastrophic diseases like breast cancer, valuable work experience; at the same measles, and various other diseases; 4.57 prostate cancer, and acute leukemia— time, millions of our countrymen now have million students no longer need to miss can be availed of for free by our poorest increased access to quality health care. school because of poverty. countrymen. But we are not satisfied with this.
8 HEALTHbeat I July - August 2012 What we want: true, universal, and holistic while at the same time raising more money of the first—beneficiaries of the Category Z health care. This begins not in our hospitals, for health. Package of PhilHealth. I’m so thankful for this. but within each and every household: And what of our students—what My child getting sick is not something to look Increased consciousness, routine inoculation, welcomes them in the schools? Will they still forward to, but if that happens, PhilHealth and regular checkups are necessary to keep first learn the alphabet beneath the shade will be there to ease the burden.” – Kristine sickness at bay. Add to this our efforts to of a tree? Will they still be squatting on the Tatualla, PhilHealth beneficiary.... ensure that we prevent the illnesses that are floor, tussling with classmates over a single This is what I have learned in the in our power to prevent. textbook?... We are ending the backlogs in 25 months I have served as your president: For example: Last year, I told you the education sector, but the potential for Nothing is impossible. Nothing is impossible about our anti-dengue mosquito traps. It is shortages remains as our student population because if the Filipino people see that they too early to claim total victory, our scientists continues to increase. Perhaps Responsible are the only Bosses of their government, are rigorous about testing, but the initial Parenthood can help address this.... they will carry you, they will guide you, they results have been very encouraging. When we assumed office and themselves will lead you toward meaningful We tested the efficacy of those began establishing much-needed reform, change. It isn’t impossible for the Philippines mosquito traps in areas with the highest there were those who belittled our to become the first country in Southeast Asia reported incidence of dengue. In 2011, traps government’s performance. They claimed to provide free vaccines for the rotavirus.... were distributed in Bukidnon—which had our achievements were mere luck, and what Last year, I asked the Filipino recorded 1,216 cases of dengue in 2010. After impact they may have as short-lived. There people: Thank those who have done their distribution, the number of cases decreased are still those who refuse to cease spreading share in bringing about positive change in to 37—that is a 97 percent reduction rate. negativity; they who keep their mouths society. The obstacles we encountered were In the towns of Ballesteros and Claveria in pursed to good news, and have created an no laughing matter, and I believe it is only Cagayan, there were 228 cases of dengue industry out of criticism. right that we thank those who shouldered in 2010; in 2011, a mere eight cases were If you have a problem with the fact the burdens with us, in righting the wrongs recorded. In Catarman, Northern Samar: that, before the year ends, every child will brought about by bad governance.... 434 cases of dengue were reported in 2010. have their own chairs and own set of books, This is my third SONA; only three There were a mere four cases in 2011. then look them straight in the eye and tell remain. We are entering the midpoint of This project is in its initial stages. them, “I do not want you to go to school.” our administration. Last year, I challenged But even this early on, we must thank If you take issue with the fact you to fully turn your back on the culture of Secretaries Ike Ona of DOH and Mario that 5.2 million of the country’s poorest negativism; to take every chance to uplift Montejo of Department of Science and households can now avail of quality your fellow Filipinos. Technology; may our gratitude and applause healthcare services without worrying about From what we are experiencing spur them into even more intensive research the cost, then look them straight in the eye today, it is clear: You succeeded. You are and collaboration. and tell them, “I do not want you to get the wellspring of change. You said: It is Challenges remain. The high better.” possible.... This is why, to all the nurses, maternal mortality ratio in our country If it angers you that three million midwives, or doctors who chose to serve in continues to alarm us. Which is why we Filipino families have been empowered to the barrios: You made this change possible. have undertaken measures to address the fulfill their dreams because of Pantawid So whenever I come face to face healthcare needs of women. We, too, want Pamilya, then look them straight in the eye with a mother who tells me, “Thank you, my Kalusugan Pangkalahatan; we want and tell them, “I will take away the hope you child has been vaccinated,” I respond: You our medical institutions to have enough now have for your future....” made this happen.... equipment, facilities, and manpower. Let’s listen to some of the I repeat: What was once impossible We can easier fulfill all these goals, beneficiaries of these programs tell us in is now possible. I stand before you today if the Sin Tax Bill—which rationalizes taxes their own words how their lives have been and tell you: This is not my SONA. You made on alcohol and tobacco products—can be changed.... (Video) “It’s a great help that our this happen. This is the SONA of the Filipino passed. This bill makes vice more expensive family is one of—if I’m not mistaken, one nation.
July - August 2012 I HEALTHbeat 9 child HEALTH
First in Southeast Asia Rotavirus Vaccine now part of the Expanded Programme on Immunization
In January, during the 13th Asian Conference on Diarrheal Disease and Nutrition (ASCODD) in Tagaytay City, Health Secretary Enrique T. Ona announced that the Philippines would introduce rotavirus vaccines as part of the Expanded Programme on Immunization (EPI). And on July 2, no less than President Benigno S. Aquino III launched the giving out of rotavirus vaccines, starting with the children living in the poorest communities which have the highest child morbidity and mortality rates from diarrheal diseases. The President said, "For this year, 700,000 infants from the families listed in our National Household Targeting System will be vaccinated. This means that we will be able to protect 700,000 children from the poorest families in our country and give them a stronger, healthier start in life." The rotavirus vaccines have been distributed nationwide to cover the said beneficiaries, and mothers of infants from 1-1/2 to 3-1/2 months are encouraged to submit their children for rotavirus vaccination to the nearest health centers in their Health Secretary Enrique T. Ona administers the oral rotavirus vaccine to an infant while President barangays. With this move, the Philippines Benigno S. Aquino III looks on during the ceremonial launch in Malacaňan Palace. became the first country in Southeast Asia to implement the World Health Organization’s be saved through simple measures that and hand washing — and this is also where (WHO) recommendation to introduce life- have been in place for some time, such as the rotavirus vaccine comes into play. saving rotavirus vaccines through its EPI. the administration of oral rehydration salt Rotavirus is a virus that infects The President continues, "And solutions, which can prevent up to 90 percent the bowels. According to WHO statistics, this is not the only way we are fighting of diarrheal deaths. But we know that rotavirus is the most common cause of to diminish the occurrence of diarrhea- these strategies work best when used with diarrhea in infants and children resulting in related hospitalization and death. Lives can preventive measures such as breastfeeding deaths of about 600,000 children and over
10 HEALTHbeat I July - August 2012 2 million hospitalizations worldwide each year. Rotavirus diarrhea exacts an enormous toll on the health of young Filipino children and the nation’s healthcare resources. Figures show that an estimated 3,500 children under age five die from rotavirus diarrhea annually (12% of all diarrheal deaths); 77% of children are infected with severe rotavirus before their second birthday; 31% of young child diarrhea-related hospitalizations are due to rotavirus; and 30% of young child diarrhea- related emergency room visits are due to rotavirus.
Rotavirus Diarrhea
Rotavirus is found everywhere Rotavirus is the most common cause of potentially fatal severe diarrhea among children worldwide. and is an incredibly resilient virus. It is easily Photo grabbed from the Internet. from spread person-to-person through contaminated hands and objects. Children quality, sanitation and hygiene. But not Although vaccination is the best can become infected if they put their fingers with rotavirus transmission which makes prevention against rotavirus infection in in their mouths after touching something prevention through vaccination the best way infants and young children, good personal that has been contaminated. This usually to protect children. hygiene such as hand washing is also happens when they do not wash their hands There is no specific medication to important in controlling the spread of the often enough, especially before eating and treat the rotavirus diarrhea. The infection is infection. after using the toilet. People who care for usually self-limiting for a few days in those Rotavirus vaccine prevents children, parents and including health care with good immunity. Treatment generally diarrhoea and vomiting caused by rotavirus and childcare workers, also can spread the consists of increased oral fluid intake to only. It does not prevent diarrhoea and virus, especially if they do not wash their prevent dehydration. On the other hand, vomiting caused by other germs. Two hands after changing diapers. severe cases of dehydration may need to different rotavirus vaccines are currently While every child is vulnerable, be hospitalized for replacing the lost fluids used in infants in the Philippines. Both children under two are the most susceptible directly through the veins. This care can be vaccines are given orally (by mouth), and to severe rotavirus infection. The out of reach for many in the poorest areas, differ in the number of doses given. The transmission of other causes of diarrhea can making prevention essential to protecting vaccines may be given at the same time as be adequately stopped by improving water child health. other childhood vaccines.
Pinoy at Amerikano sa loob ng elevator na papuntang ground floor. Huminto ang elevator sa isang floor, bumukas ang pinto, at may isa pang Pinoy na bago pumasok ay nagtanong: ED: Bababa ba? RAUL: Bababa. ALIENS AMERIKANO: Are you aliens? July - August 2012 I HEALTHbeat 11 emerging DISEASE Enterovirus 71 (Hand, Foot and Mouth Disease)
On July 4, the World Health Organization (WHO) and the Ministry of Health of the Kingdom of Cambodia issued a press release that reported a respiratory disease with neurological system symptoms affecting children under seven (7) years old. It was announced as a “mysterious disease,” and as part of the International Health Regulations, neighboring countries are forewarned to act appropriately. The first death in Cambodia occurred on April 20. A month later, 23 deaths were reported, and by June 20, there were 44 deaths. Most died within 24 hours and had exhibited symptoms including respiratory illnesses, fever and generalized neurological abnormalities. On July 6, an initial sampling taken from 24 patients found that 15 tested positive for Enterovirus 71 (EV-71). The WHO noted that the cause of the outbreak has not been fully solved and that more analysis was needed. On July 13, the joint investigation conducted by the Cambodia Ministry of Health, WHO, Institut Pasteur du Cambodge and the US Centers for Disease Control and Prevention, concluded severe complications of HFMD caused by EV-71. The investigation also revealed that the cases in Cambodia were from 14 provinces and many of the Symptoms of Hand, Foot and Mouth Disease. (Photos courtesy of DOH-National Epidemiology Center) children were given steroids at some point during their illness. However, steroid use The WHO explained that HFMD is HFMD is usually a mild disease, and nearly all has been shown to worsen the condition of a common viral illness that mostly affects patients recover in seven to 10 days without patients with EV-71. infants and children below five years old. medical treatment. It is most commonly
12 HEALTHbeat I July - August 2012 caused by coxsackievirus A16 which usually infection as a notifiable disease in the country the back of the mouth which begins as small results in a mild self-limiting disease with where all health providers, particularly red spots that blister and often become few complications. physicians, must report individual cases or ulcers. A skin rash then develops on the However, HFMD is also caused by even outbreaks. Laboratory screening of palms of the hands and soles of the feet or Enteroviruses, including EV-71, which has specimens and confirmation of cases are on the knees, elbows, buttocks or genital been associated with serious complications, done at the Research Institute of Tropical area. Patients may not get all the symptoms and may be fatal. One of the complications Medicine. of the disease. They may only get the mouth is dehydration since some are not able to On July 20, Ona confirmed EV- sore or skin rash. swallow enough liquids due to painful 71 in one of the eight (8) suspected HFMD There is no specific treatment mouth sores. Moreover, EV-71 has been cases reported to the DOH from July 10-14. available for HFMD. Instead, patients should associated with meningitis and encephalitis, A 1 year and 7-month old boy from Davao drink plenty of water and may require and may cause severe complications, City tested positive for the EV-71. The boy symptomatic treatment to reduce fever and including neurological, cardiovascular and developed fever and rashes on his hands, pain from ulcers. respiratory problems. soles of feet, mouth and buttocks on July The virus is known to be excreted In recent years, HFMD has caused 6. The boy had no history of travel outside in the feces since it is found in human outbreaks in several countries in the Asian the country. A consultation was sought at a intestines. Preventive measures include region and has become an emerging threat local health facility. He was sent home and frequent hand washing with soap and following the almost complete eradication has since recovered very well. No other cases water, particularly after touching any blister of polio. In contrast to polio, there are no were reported in their household nor in the or sore, before preparing food and eating, available vaccines against EV-71 infections. community. before feeding young infants, after using the Thousands of children have suffered and still By the month's end, July 31, the toilet and after changing diapers. It is also suffer from the same disease in Vietnam, DOH confirmed the second EV-71 associated important to dispose properly used baby China and Thaïland. In 2011, Vietnam has HFMD in a 5-year old boy from Benguet. He diapers, to clean contaminated surfaces and recorded 169 deaths from a virulent form of had mild symptoms and no hospitalization soiled items, including toys, with soap and HFMD over 110,000 reported cases. was required. water, and then disinfecting them. In the Philippines, the Department Since HFMD is an infectious of Health said that EV-71 infections occur Understanding HFMD disease, keeping infants and sick children in the country but are not included in the away from school or gatherings until they reportable diseaes. The fatal EV-71 infection HFMD is different from foot-and- are well is necessary. Avoiding close contact is still very rare in the Philippines. mouth disease (FMD) that affects cattle, with children with HFMD is also important. It Health Secretary Enrique T. Ona sheep, and pigs. The diseases are caused by will also be helpful to maintain cleanliness. placed the Bureau of Quarantine on alert different viruses and are not related. Remember, good hygiene as well in the conduct of its routine screening for HFMD usually starts with a fever, as monitoring a sick child’s condition and arriving passengers in the country’s various poor appetite, a vague feeling of being seeking immediate medical attention for ports. He also instructed the National unwell, and sore throat. One or two days after those showing severe symptoms can lower Epidemiology Center to include EV-71 fever starts, painful sores develop usually in the risk of infection. Lost in Translation TITSER: Here in my English class, you are AJIE: Because, father, mother, me! forbidden to speak in Tagalog. TITSER: What?!? AJIE: Ma'am, may I go out? AJIE: I mean... TITSER: Why? TATAY-INA-AKO!
July - August 2012 I HEALTHbeat 13 PhilHealth benefit
President Benigno S. Aquino III (third from left), Health Secretary Enrique T. Ona (second from left) and PhilHealth President Eduardo P. Banzon (extreme right) pose with the first beneficiaries of the Z-Benefit Package for catastrophic illnesses. The Z-Benefit Package There are certain illnesses that a person cannot necessarily coverage for our countrymen suffering from dire illnesses, opening prepare for and fight in the same way as other known curable new doors to Filipinos in the margins, around the margins, of society. diseases. The worst of these are what called “catastrophic illnesses” So if Aling Nena has been diagnosed with early-stage breast cancer, which are literally catastrophic to one’s health, financial situation, PhilHealth will pay for the entire course of her treatment in any of and even emotional and psychological well-being. the government hospitals contracted to provide this package: from Cancer is an example of these catastrophic illnesses that cardiopulmonary clearance and surgery, to the complete session of can lead to disability and death. The Philippine Health Insurance therapy and even radiation therapy if it is necessary.” Corporation (PhilHealth) classifies catastrophic illnesses as “Type Z” For 2012, PhilHealth has allotted three billion pesos for cases and the corresponding Z-Benefit Package is set to cover the the Z-Benefit package, 1.3 billion pesos of which will be used for cost of treatment that cost roughly P100,000 to P200,000. Among the treatment of 12,000 people afflicted with either breast cancer, those for the initial implementation are: early stage breast cancer, childhood leukemia, or prostate cancer. This is only the initial standard risk childhood acute lymphoblastic leukemia, and low to implementation of that program and PhilHealth will expand the intermediate risk prostate cancer. coverage in the coming months. “This represents a change in the way PhilHealth does Meanwhile, Health Secretary and PhilHealth Chairman of business,” President Benigno S. Aquino III said during the launch the Board Enrique T. Ona said that the most important part is that the of the Z-Benefit Package at the Malacaňan Palace on July 2. He poor, as identified by the National Household Targetting System for explained that instead of focusing on one claim or one treatment Poverty Reduction (NHTS-PR) as well as those enrolled by the local alone, the focus is on the patient himself: from the surgery to post- government units under PhilHealth’s Sponsored Program, need not operation care and even to therapy. pay a cent when they get treated for these diseases in 22 identified Aquino stated, “The Z-benefit package provides full hospitals contracted to provide the Z-benefit package.
14 HEALTHbeat I July - August 2012 laughter HEALS ANG TUNAY NA LALAKI ay paubos na...
Ikot ng Buhay Duwag Kuya
BAKLA - Ibibigay ang pera sa lalaki... JERRY: 'Pre, duwag ka, noh? FRED: Hindi na matutuloy ang LALAKI - Ilulustay ang pera para sa babae... MIGZ: Hindi, ah. kasal natin... BABAE - Pupunta sa bakla sa parlor para JERRY: Eh bakit nung biglang nag- JOYCE: Ha? Bakit?!? magpaganda. blackout, yumakap ka sa 'kin FRED: Kuya mo kasi, eh! at yumapos ka pa?!? JOYCE: Hindi noh! Gusto ka ng Kuya ko! Unfair MIGZ: Hindi ako duwag! Bakla ako! FRED: 'Yun nga ang problema, eh. Kuha mo?!? Gusto ko rin siya! Kapag girls... FRANCES: Ang ganda mo naman! 6-Pack Abs Mens ELAINE: Thank you, pareho lang naman tayo, 'Gurl. IGGY: 'Tay ! Tingnan mo abs ko! CHANCHAN: Nay, may mens na po ako! 6-pack yan! JOSIE: Anong kulay, aber?!? Kapag boys... BENJIE: Wow! Machong-macho na CHANCHAN: Dark brown, 'Nay! MIKE: Ang gwapo mo naman! talaga ang anak ko! Paano JOSIE: Lintik na bata 'to! LBM yan! L.G.: Bakla ka ba, 'Pre?!? mo nagawa 'yan, anak? Hala, maghugas ka ng puwet. IGGY: Belly dancing, 'Tay! Ambisyosang baklang 'to! Baclaran Basketball Kandila JOEL: 'Ma, bayad... Baclaran. (Nagpa-cute sabay kindat sa JUN: Magpalalaki ka nga, anak! PASTOR: Itong PUTI na kandila ang guwapong lalaking umabot JEFF: Opo, 'Tay! Sasali na nga ako sisindihan ng mga dalaga't ng kanyang bayad.) sa basketball team! binata para makakita ng tunay ERWIN: (Kumindat din sa bakla, JUN: 'Yan ang gusto ko! na pag-ibig... nagpa-cute din, at nagbayad JEFF: 'Nay, nakita n'yo ba ang PULA naman sa mga may-asawa ng kanyang pamasahe...) pompoms ko?!? para tumagal ang pag-ibig... 'Ma, bayad... Bacla-ren! LITA: Alin, anak? Yun bang pink? At ASUL sa mga balo para makakita ng bagong pag-ibig... Pakiss Gustong Babae ROMY: Eh, sa amin pong mga bakla, ano po ba ang sisindihan CHRIS: Pare pakiss naman. EDGAR: 'Pre, ano ba ang gusto mo namin?!? DANNY: Baliw! Mukha mo! sa babae?!? PASTOR: Magsindi kayo ng KATOL para CHRIS: Dali na! Pakiss 'pre... BRIAN: 'Yung hindi malikot ang ulo hindi kayo lamukin kakahintay DANNY: Anak ng... Saan ba kasi?!? kapag kinukulutan ko! ng pag-ibig. Photo floats in the Internet
July - August 2012 I HEALTHbeat 15 HEALTH access Access DOH Following the principle of Kalusugan Pangkalahatan, here are some new ways the Department of Health employs using the various kinds of media to reach more Filipinos. The Doctor Is In
Are you tired of media sensation – Assistant showbiz news and often Secretary Enrique "Eric" Tayag. obviously fabricated celebrity He is joined by a lady doctor co- gossips or controversies in late host, Dr. Darah Chavez together Sunday afternoon programming with other doctors and health of the country's giant television experts as guests in the show to stations? Well, it is time to pick- raise people's consciousness on up that remote control and health matters. switch to People's Television "The Doctor is In" (PTV-4) every Sunday, 4:30 - tackles current health issues 5:00 pm, because "The Doctor is affecting the country, health tips In." and ideal practices of individuals And that doctor is no and communities to contribute regular doctor. He is the country's to a healthier Philippines. The Health Assistant Secretary Eric Tayag (center, facing the camera) and Dr. Darah Chavez (right) will hopefully change your late Sunday afternoon foremost epidemiologist, show started airing on June 24 viewing habit to switch from the often fabricated showbiz news and gossips the Department of Health's and will run for two TV seasons to relevant health news and feature stories. (Photo by Paking Repelente spokesperson, and the social (26 episodes). and article by Rowena M. Bunoan) Health Beat on Air
Health Beat, so it seems, is not only the official Department of Health magazine, it is also now a health segment of Mornings@ ANC over at ABS CBN's cable news network. Aside from health, this 2-hour morning news and talk television program features all the information needed to start the day - local and world news from around the globe, reports and analysis from the floor of the Philippine Stock Exchange, technology, sports, environment, entertainment, along with the latest trends affecting Filipinos here and abroad. It airs from 9am to 11am on weekdays. The anchors of the show are Pinky Webb, Ron Cruz, Ginger Conejero and Paolo Abrera. DOH officials and program managers Video grab of the health segment in Mornings@ANC. often guest as resource persons in the health segment.
16 HEALTHbeat I July - August 2012 DOH Call Center & Smart Infoboard
The Department of Health, On the other hand, Smart and prevention and schools, but it has Philippine Long Distance Telephone introduced the use of Infoboard for the several other applications, including sports, Company (PLDT) and Smart Comunications, DOH to broadcast health news, updates and gated communities, and real estate. Now, Inc. (Smart) have teamed up to use a range campaigns via subscribed text broadcasts the DOH took advantage of the Infoboard for of call and text solutions to help Filipinos get and speedy reporting for citizen concerns, its programs and activities. equitable and accessible health care. These questions, surveys or disease monitoring For more information on the initiatives were presented during the DOH’s to Filipinos, straight to the Smart mobile Infoboard, contact the DOH Information 114th anniversary celebration on June 22. phones of subscribed individual members, Management Service or e-mail Smart at PLDT inaugurated the DOH Call anytime and anywhere.
DOH Assistant Secretary Gerardo V. Bayugo (fifth from left) gives a ‘thumbs up’ for the use of wireless communication technologies to achieve Kalusugan Pangkalahatan with (from L-R) Smart’s Ramon Duremdes, Louie De Guzman and Darwin Flores, PLDT’s Renato Castañeda, Anthony L. Lim and Beth Lui, DOH’s Mayleen Aguirre and Crispinita Valdez, PLDT’s Lucia Sy, and DOH’s Kenneth Ronquillo. (Photo from www1.smart.com.ph)
July - August 2012 I HEALTHbeat 17 Secured Health Information Network & Exchange
SHINE, which stands for Secured the health requirements of a patient, and Health Information Network and Exchange, is replaces most, if not all, of the paperwork an electronic medical records and electronic that goes with it. inter-facility health referral system that The platform accommodates the Smart Communications Inc. developed electronic registration of patients, recording in consultation with the Department of of consultations, filling up and sending of Health and the healthcare community. It referral, acknowledgement and feedback is a multisectoral effort to help improve forms, search for a healthcare specialist or the Philippine health system in line with facility, setting of appointments as well the Millennium Development Goals (MDG) as the sending of SMS notifications and target of reducing the maternal mortality reminders to the patient. ratio of 162 per 100,000 live births to 52 by LGUs are expected to benefit the year 2015. mainly through more accurate and faster The system can be patients, Photo shows SHINE logo and the training reports. SHINE allows the generation of conducted in Iloilo late last year with Dr. Juan doctors and other health care professionals, Antonio Perez III, director of the DOH Bureau of various reports aligned with the DOH medical resources like pharmacies and Local Health Development (far center). data dictionary and aligned with key DOH diagnostic laboratories, hospitals and reporting systems such as the Field Health health institutions like the DOH and local To a midwife at a barangay health Service Information System (FHSIS) and government units (LGUs) via the Web. station, SHINE is a means to keep patient Philippine Integrated Disease Surveillance With SHINE, health workers information updated and accurate, to and Response (PIDSR). If necessary, can also access the system via GPRS- or generate the required DOH reports faster reports can be customized according to the 3G-enabled mobile phones that can run Java and more efficiently, and to search and requirements of the LGU. applications and/or computers connected locate resources for the patient in the health Since SHINE addresses time to the Internet to register patients, record network via the convenience of a menu in consuming and repetitive documentation at consultations and services rendered or her/his mobile phone. the point of care, patients are also expected commodities provided and generally access SHINE simply makes it easier to benefit in terms of convenience, cost electronic records of individual patients. and faster for a health worker to attend to savings, and ultimately improved health. Dengue Text Blast
During the celebration of the hospitals. Moreover, the patient’s name and ASEAN Dengue Day on June 15 in the Under the system, rural health address will be given to the community City of San Fernando, Pampanga, Health units or hospitals can report suspected health team which will visit the patient on Secretary Enrique T. Ona introduced a new dengue cases to the dengue coordinator, the same day and identify other possible strategy to emphasize community action who would forward the message to the patients in the neighborhood and will advise against dengue by tapping information Philippine Information Agency (PIA) and to them to seek medical consultation. Searching technology to implement ‘specific targeting' the community health team. The PIA will and destroying mosquito breeding places is of dengue cases in communities in an effort then conduct a mobile phone ‘text blast’ in still the main message among community to significantly reduce cases and deaths. This the affected area about dengue prevention members. process would allow real-time reporting of while the health teams will conduct According to PIA Regional Director dengue cases from rural health units and investigation. Robert Baldago, “PIA has collaborated
18 HEALTHbeat I July - August 2012 with the National Telecommunications Commission (NTC), Smart Communications and Globe Telecom to allocate a total of 100,000 monthly free text messages per PIA regional office which will be used in sending free information on dengue prevention and control. Text messages will be sent directly to various stakeholders, partners and barangay officials of the affected communities.” Aside from information on dengue, Baldago said that the ‘text blast’ will also be used to send free public advisories on other health risks and calamity warnings such as flood and typhoon notices to recipients segmented by provinces, sectors, occupations and genders. “The ‘text blast’ for dengue Health Secretary Enrique T. Ona announces a new strategy to emphasize community action against warning is pilot-tested in Pampanga and dengue by tapping information technology to implement ‘specific targeting’ of dengue case. This will eventually be implemented in other strategy is in partnership with the Philippine Information Agency. (Photo by Paking Repelente) provinces in the country,” said Ona. ASEAN e-Health Bulletin
The Philippines is the lead It prioritizes articles that shepherd in the publication of ASEAN showcase the achievements of regional e-Health Bulletin launched at the 11th health cooperation, particularly in HIV/ ASEAN Health Ministers Meeting in Phuket, AIDS, communicable diseases, traditional Thailand on July 5. Health Assistant medicine, pharamaceutical development, Secretary Enrique A. Tayag is the editor and disaster management, maternal and child Anthony R. Roda, OIC-Division Chief of the health, non-communicable diseases and National Center for Health Promotion, is the tobacco control, among others. focal point. The ASEAN e-Health Bulletin is The ASEAN e-Health Bulletin is also a venue for sharing good practices in published biannually by the Health and health initiatives that address gaps common Communicable Diseases Division (HCDD) or shared by other ASEAN member states. It of the ASEAN Secretariat based in Jakarta, also posts future announcements of regional Indonesia. It is also posted on the ASEAN events. website. - o O o -
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July - August 2012 I HEALTHbeat 19 HEALTH promotion
TELLING OUR STORY From Personal Gains to Advocate
A family in Compostela Valley turns into a family health advocate.
Many young couples in Maragusan, a municipality in the province of Compostela Valley in the Philippines had limited opportunities to learn about different family planning options available to them. As a response, USAID, through its Health Promotion and Communication project, provided technical assistance to the Compostela Valley local government by training health service providers and volunteers how to communicate and counsel “...Because of our couples effectively in voluntary family planning and to conduct health classes. One of the young couples decision to space benefiting from this training was Dan and Analy Casie. The Casie family took advantage of the new family health services offered by the municipality. births, we can make Supported by her husband, Analy completed all the required antenatal check-ups, gave birth in a health center ends meet even with to a healthy daughter, and practiced exclusive breastfeeding. The Casie family decided to wait a few more years before their next child. They met with the local midwife and together made the decision to have Analy use the meager resources injectables – an effective temporary family planning method – to space their next child. that we have.” Experiencing firsthand the advantages of caring for the health of his family and spacing their children, Dan has become an advocate and spokesperson of male involvement in family health in his community. He now works - Dan and Analy Casie, closely with the Municipal Health Office to reach more families with family planning and safe motherhood Compostela Valley messages. In recognition of his endeavors to share the responsibility of ensuring his wife’s safer pregnancy and planning their family, Dan was awarded Most Responsible Father during a municipal-level Safe Motherhood health event. As Dan and Analy ensure that their daughter gets the care and love she needs, they have become enthusiastic family health advocates, encouraging other couples in their community to prepare a birth plan, complete Reprinted with permission from “Telling Our prenatal and postnatal care, bring their children to the health center for timely immunizations, and use family Story” by the US Agency for International planning to space births. Development
20 HEALTHbeat I July - August 2012 RESEARCH brief
July - August 2012 I HEALTHbeat 21 HEALTH promotion Interactive Komiks: Educating a New Breed
Introduction komiks’ colorful and attractive images with its simple and relatable plot make for a simple yet effective tool for visual-loving Filipinos, In August 2011, the Department of Health with technical assistance but what makes this komiks special is that it follows an interactive from the US Agency for International Development (USAID) produced format. an interactive komiks, titled Antonio at Ellen: Isang Labs Story. The komiks tells the story of a typical Filipino couple who makes decisions In each chapter of the story, the reader is encouraged to make the for their family everyday. The komiks became an instant hit among decision on behalf of the main characters. Each choice will lead to a mothers and health workers. It is now being used at health centers specific resulting scenario, which signifies that every decision bears a while clients wait for their turn or during health classes when health consequence for the characters. education facilitators punctuate their key messages with scenes from the komiks.
In the Philippines, komiks were the most widely read periodicals in the 1980’s, with dozens of titles sold on newsstands every day1. From its humor-based origin, modern comics have evolved to include stories from other genres such as suspense, horror, fantasy and romance. Despite the decline of the komiks industry over the years with the introduction of new technologies and other forms of entertainment, this genre remains a familiar medium among many Filipinos and Ultimately, the komiks aims to educate young couples on the now serves as a new interactive health education tool. relevance of the characters’ story in their own lives. In the process, it enjoins its readers to learn about and practice healthy behaviors on Ikaw at Ako ay Tayo planning for their family’s future.
In January 2012, staff and technical specialists of the Department of Own a Copy of this Interactive Komiks Health's National Center for Health Promotion attended a workshop on social and behavior change communication supported by USAID’s By following the 5 simple steps below, you can now have your own Health Promotion & Communication Project. At this workshop, a copy of the interactive komiks: communication plan to promote spousal communication as an essential ingredient in family health was hatched. Thus was born 1. Detach 3 middle spreads with Ikaw at Ako ay Tayo from this Ikaw at Ako ay Tayo, DOH’s second interactive komiks on family health. HEALTHbeat issue starting from page 21. 2. Cut detached spreads in the middle where the staples used In its storyline, the komiks integrates a broad spectrum of maternal, to be. You will have six individual sheets. newborn and child health, nutrition and family planning messages 3. Separate komiks pages from the instruction page, and fold utilizing the life-cycle approach, which promotes care for mothers them in the middle in the given order. and children from pregnancy to delivery, postpartum period, and 4. Staple komiks twice along the fold. childhood, recognizing that safe motherhood, child care and family 5. You now have your own copy of the interactive komiks! planning are essential to the health of both the mother and child; Use it in health facilities during health classes, individual and that a healthy start in life is essential to the long-term health and or group counseling, or in the waiting areas. wellbeing of each child.
This time, the readers meet the Sonrisa family of Mike and Tess. The 1 http://planetphilippines.com/entertainment/komiks-industryfights-for-survival/
22 HEALTHbeat I July - August 2012 July - August 2012 I HEALTHbeat 23 24 HEALTHbeat I July - August 2012 July - August 2012 I HEALTHbeat 25 26 HEALTHbeat I July - August 2012 July - August 2012 I HEALTHbeat 27 28 HEALTHbeat I July - August 2012 July - August 2012 I HEALTHbeat 29 30 HEALTHbeat I July - August 2012 July - August 2012 I HEALTHbeat 31 32 HEALTHbeat I July - August 2012 stress RELIEF BRUHA KA Ahihihi Pak Awww
ROSE: Mare, alam mo ba na ang mga CHICHI: Hoy! Bakit ka ganyan RACHEL: Bakit ang landi mo? witches ay hindi nagsusuot ng makatingin sa boobs ko? AILEEN: Affected ka? Ikaw kaya ang panty?!? HAROLD: Bakit masama ba? Eh, meron maging maganda na tulad ko, ARLYN: Talaga, Mare? Bakit? akong mga mata! mananahimik ka ba?!? ROSE: Siyempre, para maipit nila nang CHICHI: Puwes, 'etong sa ‘yo! maigi ang walis. (Sinampal ang lalaki.) Yehey ARLYN: Ay, kaya pala tawa sila nang tawa HAROLD: Bakit mo ako sinampal? habang lumilipad kasi nakikiliti CHICHI: Masama ba?!? Eh, meron JOEREM: Honey, sino ang tinitingnan mo? ang mga bruha. akong kamay! LEN: 'Yung isa sa nakikipag-inuman ROSE: Hihihi. Bruha ka talaga, Mare! sa kanto. Siya ang ex ko, hon! ARLYN: Mas bruha ka, Mare! Hihihi. Ngek I heard, naging lasenggo na siya after our break-up five years ago. Tik-Tak NEIL: Pakasal na tayo? JOEREM: Grabe! Ang tagal naman ng MACON: Sige celebration niya! JAMES: Miss, anong oras na? NEIL: 'San mo gusto? Sa pari o JOY: Sorry, wala akong relo, eh. sa Judge? Blagag JAMES: Oh talaga? E balitang balita sa MACON: Syempre sa 'yo! Engot na 'to... bayan na two-timer ka! At inirereto pa ako sa iba! EMAN: Lalayas na ako. ELLEN: Ha?!? Bakit?!? Mwaah Bang EMAN: Bakit ako lalayas? ELLEN: Hindi! Ang ibig kong sabihin, MARIO: Nakita kita sa mall kagabi. JUDGE: Totoo bang binato mo ng bakit ngayon ka lang lalayas! Sino yung ka-date mo? silya ang iyong asawa? Ipinagpalit mo na ba ako sa ERA: Opo, your honor! Ahem kanya? JUDGE: Bakit mo ginawa 'yon? JOAN: Love, hindi naman kita ERA: Eh, hindi ko po mabuhat RUBEN: Matatanda na tayo, pero dapat pinagpalit eh, nagdagdag 'yung mesa! matalas pa ang memory natin. lang ako. Mwaah. Pwede ba kitang subukan? Pwe RIA: Aba oo! Sige tanungin mo ako? Boom RUBEN: Five plus five? ERMING: Mare, pangit ba ako? RIA: Twelve, right?!? GERRY: Pwede bang manligaw? AURING: PangIt ang nanay mo, pangIt RUBEN: Matalas pa rin memorya mo! JUVIE: Oo naman. Basta 'wag lang tatay mo, pangit mga kapatid Magaling ka pa rin sa English sa akin. mo. Ano ka, isang himala?!? hanggang ngayon.
Photo grabbed from
July - August 2012 I HEALTHbeat 33 HEALTH research Inequalities in Non-Communicable Diseases* by VALERIE GILBERT T. ULEP, MD and JOHN JULIARD GO, MD
The epidemic of among the poorer segments. non-communicable diseases Hence, it can be argued that (NCDs) is increasing rapidly NCD risk factors can now in emerging economies, be found in all population particularly in Asia-Pacific. In segments, regardless of socio- the Philippines, epidemiologic economic status (SES). transition from infectious to non-infectious type of illnesses Macro-Social Determinants has been observed. Using the National Statistics Office The epidemic and death registry, approximately inequality in NCDs can be 76 percent of the total deaths conceptually organized in are non-infectious in nature Figure 2. Dr. David Stuckler (see Figure1). Fifty four (54) RICH AND POOR. Consumption of unhealthy food is higher among the rich. (2006), of the Department Smoking is higher among the poor. And a quarter of the adult population is percent of deaths are due to alcohol drinkers, and the prevalence is similar to all socio-economic class. (Photo of Sociology in University of the “fatal four” NCDs, namely, grabbed from
--- *Based on the study entitled "Developing a National Strategy to Address the Determinants of Inequities in Non-communicable Diseases (NCDs): Mapping Phase" conducted by the Philippine Institute for Development Studies (PIDS), commissioned with the World Health Organization (WHO) for the Department of Health. The authors of this article – Dr. Valerie Gilbert Ulep is a Supervising Research Specialist for Health at PIDS and Dr. John Juliard Go is currently the Technical Officer for NCDs at WHO Philippines Office.
34 HEALTHbeat I July - August 2012 factors. As population’s income level and practices have also modified the dietary capita was also noticed for animal fats and increases, people’s behavior, consumption preferences and food composition of typical sweeteners. Process in trade has contributory and expenditure change. Rapid growth diet. Today, there is a noticeable dietary shift effect on the emergence of NCDs. As the opens doors to modify a population’s risk just towards high in fat, refined carbohydrates world becomes more globalized and more as their lifestyle catch up to their newfound and low-fiber diet in most countries. There is countries commit to trade liberalization, wealth. This scenario is a growing trend in a decreasing supply per capita of vegetable the landscape of food supply changed most emerging economies like China, India, products vis vis increasing supply per capita drastically. Changes in food supply from Philippines and other countries in Asia and of meat products. Increasing supply per traditional to Western and processed food Latin America. One of the processes related to Figure 1. Share of Total Deaths by Cause, Philippines, 2008 economic growth is rapid urbanization. In (Source: Calculation of data from the National Statistics Office) developing Asia, the growth of urbanization is very fast compared to the rich countries. To cope with the fast pace in urban areas, many people resorted to dietary and lifestyle changes. The flourishing opportunities in different industries which are highly concentrated in major cities drive many people from rural to urban areas. Consequently, the high urbanization rate will then affect food and lifestyle dynamics. In urban settings where food production is concentrated, manufacturers take advantage of economies of scale. This leads to lower prices encouraging people to eat outside the home. Urbanization may also promote physical inactivity as a result of fast and convenient transport system. Figure 2. There is a growing concern that Priority Public Health Conditions Knowledge Network NCDs is now also shifting to the poorer Framework of the World Health Organization segments in developing countries. Many studies establish that the urban poor population has a higher risk of acquiring NCD compared to the rural poor. This can be attributed to different factors like higher level of stress due to physical and environmental pollution (e.g. overcrowding and noise), the rampant consumption of unhealthy diet (e.g. pre-cooked food sold in the streets) and the lack of access to health service which hinders early diagnosis. The rapid industrialization has changed the methods of production, processing, distribution and marketing of food products. The marketing techniques
July - August 2012 I HEALTHbeat 35 can be driven by different factors. and oils in the past two decades. In meat dangers of secondhand smoking on health. However, in general, the influx of and related preparations, the country In the Philippines, 31 percent of the adult Foreign Direct Investments (FDI) has been imported 41 million kilograms in the early population are current smokers and 14 very instrumental in changing the type 90’s compared to 381 million kilograms in percent used tobacco in the past. The of food available in the market. FDI is the 2010, a 32 percent annual increase. A similar prevalence of smoking is significantly higher investment of foreign assets into domestic pattern was also observed in other food among the poor adults. structures, equipment, and organizations. items especially animal and vegetable fat. Alcohol is causally linked (to In most cases, as foreign companies acquire varying degrees) to different cancers, large shares and pour investments to local Exposure and Vulnerability Factors cardiovascular diseases, liver disease and food firms, they can now produce, retail pancreatitis. In the Philippines, about and distribute locally and globally accepted The macro-social conditions put a quarter of the adult population is alcohol products. Conditions for FDI were facilitated population group more at risk to different drinkers, and the prevalence is similar across through the easing on FDI regulations as part exposures which eventually lead to them to all socio-economic classes. of structural adjustment programs and free higher odds of having NCDs. The major NCDs Vulnerabilities occur as synergistic trade agreements among countries. FDI has are known to share common risk factors: effect of different exposures. Three important played a critical role in the diet transition. consumption of unhealthy diet, smoking, vulnerabilities are featured in this study, It has especially targeted highly processed sedentary lifestyle and alcohol consumption. namely: obesity, total blood cholesterol and foods. There is a close relationship between Dietary and nutrition, as modifiable risk hypertension. In the Philippines, around 5 a rise in FDI and increased investments in factors occupy prominent position in the percent of the population is now considered processed foods. In most emerging markets prevention and control NCDs. to be obese, 10 percent are diagnosed with like the Philippines, FDI in food industries In the past decade, there was an hypercholesterolemia and 24 percent are grew significantly. Though the country is observable increase in the consumption considered hypertensive. In several time experiencing fluctuations of total value FDI of unhealthy food items (i.e., saturated series analyses, there is an increasing in contrast to many ASEAN (Association of oil, meat and sugar), and decrease in the trend of borderline obesity and total blood Southeast Asian Nations) countries, food consumption of complex carbohydrates like cholesterol. and beverage industry is one of the few root crops and vegetables. Analysis of the Disaggregating the prevalence industries that sustained growth from 1980 latest National Nutrition Surveys reveals by socio-economic status and other to 2007. At present, 41 percent of FDI in higher consumption of unhealthy food welfare indicators like educational manufacturing are from food and beverage items among the richer segments. However, attainment and urbanity reveals positive production. synergistic analysis of urbanity and socio- correlation between obesity and total Under the free trade liberalization, economic status reveals a high consumption cholesterol but no discernable correlation countries can now also readily ship goods, of the urban poor of several unhealthy food in hypertension. In other words, obesity materials and services beyond their political items including food oil and food outside and hypercholesterolemia are more likely to and economic boundaries. Undoubtedly, it home which is considered being high in occur among the richer population. has positive impact on domestic economy, saturated oil and sugar. but lowering trade barriers is also directly Tobacco use is considered as one Why Invest in NCD Prevention associated with increased an import which of the commonly shared risk factors of major and Control for the Poor? then leads to greater availability of goods NCDs like cardiovascular diseases, certain including tobacco, alcohol and processed cancers and diabetes mellitus. Smoking Contrary to prior beliefs, NCDs are not foods. In the Philippines, the quantity is also linked with chronic obstructive anymore just diseases of the affluent. The of import is more than twice the export, pulmonary disease and injuries. Thus, study clearly illustrates that NCD risk and ascertaining the country’s reliance on quitting smoking can significantly reduce vulnerability factors are now eminent in imported food items. In addition, there various forms of illness. The harmful effect all socio-economic groups. The poor are was a significant increase in the quantity of smoking is not solely found in smokers. particularly exposed to tobacco use and of imported food like meat, dairy products Many studies have also implicated the high salt consumption, and will likely suffer
36 HEALTHbeat I July - August 2012 from NCDs in the future. About a quarter not seemingly be politically attractive as into action. One of the most effective ways of NCD deaths are also happening below results are not observable in the short-term, in institutionalizing a national multisectoral age 60 years, and contribute further to lost but this frame of mind should be changed strategy is to convene different sectors productivity and to the vicious cycle of NCD and advocacy efforts should continue to rally of society for consultation and dialogue. and poverty. more substantial policy- and programme- Organizing and setting responsibilities NCD is comparable to a wave. level support for addressing NCDs. of individual institutions can maximize The current disease patterns of developing complementary strengths and synergy of countries like the Philippines where Moving Forward actions that would yield to better results. infectious diseases are plummeting while • Promotion of healthy lifestyle NCDs are emerging was experienced by By presenting the current situation should be strengthened and scaled up, many Western developed countries 50-70 of NCDs especially the determinants and not just through health education and years ago. In those years, the epidemic of inequalities, it is hoped that this will facilitate awareness-raising campaigns but through NCDs usually afflicted the richer segment and strengthened interest and commitment ensuring the provision of supportive eventually shifted to the poorer population. among stakeholders to accelerate national policy and physical environments for the Given the wave-like characteristic, the initial and local efforts in addressing NCDs. practice of healthier lifestyles. Healthy contact of NCD in developing countries The Department of Health, as the settings – health-promoting schools and is usually the richer segments, and it is lead institution, can consider some of the healthy workplaces – should continually be projected to occur in the poorer segments following recommendations: encouraged. in the long term. The shift from rich to poor • The country should define a more • The possibility of creation a can be attributed to several behavioral, aggressive position on combating NCDs and health promotion foundation which will environmental and economic conditions. their risk factors. Risk factors like unhealthy design and oversee innovative and effective Prevention and control of NCDs food, alcohol and smoking are hard to health promotion campaigns in the country should start very early. As the wave regulate because of the possible political and should be explored. would likely fall on the poorer segments economic backlash once controlled. National • Delivery of essential NCD as ascertained by global experience, it is position on tobacco control is already well- interventions at the primary care level, with necessary to educate and promote healthy defined as enshrined in several laws and effective referral systems, should be ensured. lifestyles among the poor to prevent NCDs. policy guidelines but needs additional Rural health units often provide the first As the richer segments have more provisions features and refinements (i.e. sin tax laws, interface of the poor with the health system. and access to mitigate or alter the effect graphic warnings). However, regulation of Enhancing access to essential medicines and of NCDs, the poorer segments would not unhealthy food and alcohol seems very lax. services of the poor and providing measures have enough resources or chances to do so, In setting a national position, all risk factors for their financial risk protection can help specifically the curative phase of NCDs. Thus, that are feasible for regulation should be reduce inequities due to NCDs and risk if not addressed in a timely and appropriate well-identified, and the level and kind of factors. manner, catastrophic effects would be regulation should also be set. • The national strategy should higher among the poor. • The country should develop a include a provision that open doors for Public health managers in charge national multisectoral plan to address the more researches that tackles NCDs. Building of tackling NCDs should think long term. The drivers of NCDs. A whole-of-government and research centers that focuses on NCDs would agenda of NCD prevention and control may whole-of-society approach should be put lead more to collaboration and network.
YOUNG MAN's love affair is ROMANCING. MIDDLE AGE MAN's love affair is WOMANIZING. OLD MAN's love affair is FINANCING.
July - August 2012 I HEALTHbeat 37 tobacco CONTROL DOH releases the National Tobacco Control Strategy
On July 24, the Department synchronize all tobacco control efforts of of Health released the National Tobacco the DOH organization as well as enjoining Control Strategy (NTCS), the country’s other government and non-government first-ever comprehensive and coordinated organizations through the mobilization approach with clear and measurable of Sector-Wide Anti-Tobacco (SWAT) targets to be achieved by 2016. committees. The NTCS reflects the Tobacco is the single most government’s political commitment to preventable cause of death in the world strengthen national capacities to address today. It is the only legal consumer the rising incidence, developmental product that can harm everyone exposed challenges, the social and economic to it and kills up to half of those who use it impact of non-communicable diseases as as intended. It also kills 10 Filipinos by the reflected in the United Nations Political hour due to tobacco-related diseases. And Declaration on the Prevention and Control unlike many other dangerous substances, of NCDs and to move for the complete tobacco-related diseases usually do not implementation of the World Health begin for years or decades after tobacco Organization Framework Convention on use starts. Because developing countries, Tobacco Control (WHO FCTC) to protect like the Philippines, are still in the early Cover of the NTCS. public health from the devastating effect stages of the tobacco epidemic, they of tobacco use. have yet to experience the full impact of In the Philippines, two of the 10 related diseases through well planned and tobacco related diseases and deaths already leading causes of morbidity and seven of designed strategies. evident in the wealthier countries where the 10 leading causes of mortality today are For the Philippines to implement tobacco use has been common for much of NCDs. The major causes affecting the lives of the WHO-FCTC, the country, under the the past century. the people are linked by the common and leadership of the DOH, engaged all relevant Tobacco use is common in the preventable biological risk factors – high sectors of government, civil society, and non- country due to its low price and easy access, blood pressure, high blood cholesterol, governmental organizations to take action aggressive and widespread marketing, overweight; and by related major behavioral within their social, cultural, occupational, lack of awareness about its dangers and risk factors – unhealthy diet and nutrition, and political networks and spheres of inconsistent public policies against its uses. physical inactivity, excessive alcohol drinking influence, and came up with the Philippine The cure for this devastating epidemic is and tobacco use. NTCS 2011-2016. The twin goals of the dependent on concerted actions of people With the vision of “Tobacco-free Strategy are the attainment of the lowest in the community, government and civil Philippines: Healthier People, Communities, possible prevalence of tobacco use and the societies. and Environments,” the NTCS builds on the highest level of protection from secondhand A series of NTCS dissemination premise that future generations of Filipinos smoke. forums were held in key cities of Luzon, will be given the right to live in a protected The DOH also announced the Visayas and Mindanao in July and August. environment and communities freed from establishment of a National Tobacco Control Here, the DOH enjoined its partners and the the bondage of tobacco use and relieved Coordinating Office lodged under the public at large to make it happen. from the socio-economic burden of tobacco- National Center for Health Promotion to - o O o -
38 HEALTHbeat I July - August 2012 HEALTHY workplace Belly Big? Belly Bad! by RHODERIC N. DOMINGO National Center for Health Promotion
I've been chubby all my life, but new workplace weight loss program, I was degenerative arthritis, gout, and gallbladder somehow I could still tuck my tummy in to personally handpicked by my supervisor to diseases. With the various medical a deceiving desirable figure. But not now, I do the job. "Okay, just rub it in some more," consequences associated with ovenutrition, already have grown so big. Blame it on my I said to myself, "Kapag ako pumayat, ewan this weight will contribute to decreased previous year-long work in a Call Center. ko na lang..." productivity and economic growth Don't get me wrong, I'm not saying that retardation. business process outsourcing companies did Overnutrition Overnutrition has been recognized this to me, it's just that I turned to the bad as a public health problem, particularly habit of binge eating and physical inactivity Overnutrition, i.e. overweight and in developed countries where there is an at work, and oversleeping after work hours. obesity, is a serious health concern especially abundance of food and supply and physical Thank goodness I landed in a job in in the light of its strong association with activity continues to diminish due to the Department of Health at the start of this the development of non-communicable automation and mechanization. According year, and hopefully, things will change for diseases (NCDs) which are among the to studies of the Food and Nutrition Research the best for my weight. "You wish," became leading causes of mortality, morbidity and Institute (FNRI) of the Department of Science the pranks of some officemates. Yet, I'm disability in the country today. These NCDs and Technology (DOST), among adults 20 quite determined to lose some weight whicl include cardiovascular years old and over in the Philippines, a trend led me to participating in a "Fitness Camp" diseases, cancer, was noted towards an increase in overweight conducted by the DOH Degenerative Disease diabetes mellitus, at 0.67 percentage point annually for the Office (DDO) of the National Center for hypertension, past 15 years from 1993 to 2008. This trend is Disease Prevention and Control (NCDPC) in renal diseases, an indication that such age group has higher May. But fate had its way of risk to lifestyle degenerative NCDs. playing a joke on me Based on waist and hip because when a circumference among adults, females were request came more at risk than males to high waist and to our office hip ratio and high waist circumference as to design they grow older. High weight-height ratio some and high waist circumference in females health recorded an annual average increase of 2.6 promotion and 0.83 percentage points, respectively, materials from 1998 to 2008. However, overweight for a lactating mothers recorded an annual average increase of 0.25 percentage point from 1998 to 2008. Moreover, the 2008 National Nutrition and Health Survey revealed that across population groups, there is an emerging concern in the increase in
July - August 2012 I HEALTHbeat 39 BELLY GUD FOR HEALTH, workplace weight loss advocacy campaign initiated by the Degenerative Disease Office of the National Center for Disease Prevention and Control and piloted in the DOH Central Office involves waist circumference measuring and monitoring, diet and physical activity lectures and exercise sessions as well as recognition and awards to top performers. (Photos by Frederick C. Pereňa) overnutrition over the years, while males and easy measure of the amount of visceral of June. All employees were required to being more vulnerable than females. fat or central obesity among adults and undergo this and experts from the FNRI- Android or apple-shaped obesity was a significant indicator of risk for NCDs DOST were the ones measuring them. prevalent particularly among Filipino particularly heart disease and stroke. Employees found to have high waist women. Apple-shaped obesity was six The campaign is being pilot-tested circumference were selected to volunteer in times more common in women than men, among DOH Central Office employees and the series of healthy lifestyle interventions, affecting 7 in 10 women and 1 in 10 men, if it would turn out to be successful will particularly engaging in diet and physical respectively. become a model for advocacy and health activity. The criteria for selection are: males intervention to reduce the prevalence of with over 90 centimeters (cm) and females Belly Gud For Health overnutrition as indicated by high waist with over 80 cm waist circumference. circumference. Already in the offing to follow Unofficial results coming from In a play of words creating a suit are the employees of the Cabinet's the DDO-NCDPC revealed an average of new health meaning to the expression human development and poverty reduction more than 50 percent of employees that "very good," the DOH introduced "Belly cluster. Who knows, this will become the were measured per office have high waist Gud for Health" – an advocacy campaign standard in public and private workplaces circumference. Obviously, I am included in strategy that is envisioned to be a light and soon? this statistics with 109 cm. Fortunately, or is enjoyable challenge for people to be fit by This weight loss campaign started it unfortunately, I belong to the majority. attaining and maintaining a desirable waist with measuring waist circumference of The volunteers are expected to circumference. employees during the week-long DOH attend the monthly half-day session on Waist circumference is a simple anniversary celebrations in the last week nutrition and physical activity from July
40 HEALTHbeat I July - August 2012 to December. Experts on nutrition and prayer and some isometric exercises. desireable waist circumference at the final physical activity coming from government Then the volunteers will undergo measurement, the one with the greatest and private sectors, academe, fitness gyms a monthly monitoring and recording of cumulative reduction in six months will be and other institutions are scheduled to waist circumference to gauge individual declared the winner. He/she will receive a be resource speakers in lectures, physical progress. Non-cash incentives are provided plaque of recognition and P5,000 cash. exercise regimens and other relevant to top performing participants at the time Meanwhile, participants who activities. of measurement that will serve as reward for reach or maintain a desirable waist The learning from the month's their effort as well as reinforce their positive circumference will be given a certificate of session are adopted thru an hour-long behavior. recognition and P1,000 cash And for those afternoon physical exercises or activities on And on the first Monday of the who will not reached the desireable waist Mondays thru Thursdays until new routines New Year, awards will be provided. One circumference but achieved the greatest are taught in the following month. Jogging participant will be declared as the Grand cumulative reduction within the six months or walking is reserved on Fridays inside the Winner. He/she must have the greatest period will also receive the same prize. DOH compound. This process goes on for six cumulative reduction in waist circumference All other participants who joined months or up to December. in the span of six months and must have for six months will be given consolation The volunteers are also encouraged reached or maintained a desireable waist prizes. The office with the greatest to attend the aerobic exercises at the DOH circumference. In case of a tie, the participant percentage of participants who joined will Gym on Tuesdays and Thursdays. They are with the most number of attendance in also be given a consolation prize. also expected to participate in ‘ALA STRES’ monthly nutrition and physical activity I wonder, will I ever get a prize at (read: Walang Stress) at 3:00 pm everyday sessions will be the winner. And in the event the end of this campaign? when DDO-NCDPC leads them in a short that none of the participants reaches his/her - o O o - KALAbeat Bakit Tayo Nabubuhay Nang Ganito Katagal?
Dumating na ang araw na dapat nang punuan ng Diyos po ang buhay na ganito, magpatawa nang 20 taon? Huwag naman po. ang mundo. Ang una niyang nilikha ay ang KALABAW. Ang sabi Kung ibinalik sa Inyo ng aso ang 10, ganoon din po ang gagawin ko. Okay Niya, “Pumunta ka sa bukid, magtrabaho at tiisin ang init ng araw at lang po sana sa Inyo.” At napilitang sumangayon muli ang Diyos. pagkatapos ay gumawa ka ng gatas para sa iyong amo. Bibigyan kita ng At hanggang sa nilikha na ng Diyos ang TAO. Ang sabi niya, buhay hanggang 60 taon.” Ang sagot ng kalabaw, “Mahirap na buhay sa "Kumain, maglaro at matulog. Ito lang ang iyong gagawin… ang loob ng 60 taon ang ibibigay po Ninyo. Bigyan nalang po Ninyo ako ng 20 magpakasaya. Bibigyan kita ng buhay hanggang 20 taon.” Ang sabi ng taon at ibabalik ko sa Inyo ang 40 taon.” At sumangayon ang Diyos. tao, “Ano po, 20 taon lang? Huwag naman po. Maaari po kayang kunin Pagkatapos ay nilikha ng Diyos ang ASO. Ang sabi Niya, ko nalang ang 40 taon ng kalabaw, 10 taon ng aso at 10 taon ng unggoy “Umupo ka sa labas ng iyong tirahan at kahulan ang sinumang dadaan na isinauli sa Inyo. Magiging 80 taon po lahat ang sa akin.” Ang sagot ng sa harap nito. Bibigyan kita ng buhay hanggang 20 taon.” Ang sagot Diyos, “Okay, pagbibigyan kita.” ng aso, “Napatagal po nang panahong ito para sa pagkahol lamang. Ito ang dahilan kung bakit sa loob ng unang 20 taon, ang tao ay Bigyan nalang po Ninyo ako ng 10 taon, at ibabalik ko po sa Inyo ang 10.” walang ginawa kundi ang kumain, maglaro at matulog; ang sumunod na Napabuntung-hininga ang Diyos na sumangayon. 40 taon ay maging alila sa pagtatrabaho upang suportahan ang pamilya; Sumunod, nilikha ng Diyos ang UNGGOY. Ang sabi niya, ang susunod na 10 taon ay magpatawa at magpaligaya ng kanyang mga “Maging aktibo ka, ilabas ang iyong angking galing na magpatawa at apo; at ang huling 10 taon ay umupo sa labas ng pinto at sigawan ang magpaligaya.” Bibigyan kita ng buhay hanggang 20 taon.” Nakakabugnot lahat nang dumadaan.
July - August 2012 I HEALTHbeat 41 sexual HEALTH B E W A R E O F Untreatable Gonorrhea
"Superbug" effective treatment for patients.” Antimicrobial (or drug) resistance Last year, scientists reported is caused by the unrestricted access finding a "superbug" strain of gonorrhea to antimicrobials, overuse and in Japan in 2008 that was resistant poor quality of antibiotics, as to all recommended antibiotics. well as natural genetic mutations They warned then that it could within disease organisms. In transform a once easily treatable addition, gonorrhea strains tend infection into a global health to retain genetic resistance to previous threat. antibiotics even after their use has Last June, the World been discontinued. The extent of this Health Organization (WHO) said those fears resistance worldwide is not known due to are now a reality with several countries, lack of reliable data for gonorrhea in many including Australia, France, Japan, Norway, countries and insufficient research. Sweden and the United Kingdom reporting Unfortunately in the Philippines, cases of the sexually transmitted infection inappropriate and improper use of resistant to cephalosporin antibiotics – the antibiotics has long been a major last option for drugs against gonorrhea. problem, and these practices promote Every year, an estimated 106 the emergence of untreatable gonorrhea. million people are infected with gonorrhea. Among these practices are: self-medication It is one of the most common sexually or buying antibiotics without consultation transmitted infections (STIs) in the world with a doctor; skipping a dose of antibiotic; and is most prevalent in south and southeast not finishing the prescribed treatment course Asia and sub-Saharan Africa. of the antibiotics; and using antibiotics like In the Philippines, information Drug-resistant gonorrhea over-the-counter drugs, meaning without is said to be on the rise worldwide. about gonorrhea and other STIs is limited (Artwork floats in the Internet.) doctor’s supervision. because the official statistics come only from government-run treatment centers, and it About Gonorrhea is probable that the vast majority of people public health challenge. Dr Manjula with STIs are treated outside these centers. Lusti-Narasimhan of the Department of Gonorrhea is a bacterial sexually The prevalence rate of the gonorrhea in the Reproductive Health and Research at WHO in transmitted infection. It can grow easily in Philippines is placed at 1% of the general Geneva said, “The available data only shows the warm, moist areas of the reproductive population. the tip of the iceberg. Without adequate tract, including the cervix, uterus, and This high incidence of infection surveillance we won’t know the extent of fallopian tubes in women, and in the urethra accompanied by dwindling treatment resistance, and without research into new (urine canal) in women and men. The options will make gonnorhea a major antimicrobial agents, there could soon be no bacteria can also grow in the mouth, throat,
42 HEALTHbeat I July - August 2012 eyes, and anus. elude antibiotics but it also developed cure gonorrhea. Medication for gonorrhea A person can get gonorrhea by less painful symptoms. Before, if a person should not be shared with anyone. Although having sex (vaginal, anal or oral sex) with had urethral gonorrhea, it would be very medication will stop the infection, it will not someone who has the disease. Gonorrhea painful to urinate; it is like passing razor repair any permanent damage done by the can still be transmitted via fluids even if a blades. Now, it is not that painful anymore disease, like infertility. Drug-resistant strains man does not ejaculate. Gonorrhea can also and people with gonorrhea sometimes only of gonorrhea are increasing, and successful be spread from an untreated mother to her notice the discharge if they look when they treatment of gonorrhea is becoming more baby during childbirth. People who have urinate. The organism has readjusted itself difficult. If a person’s symptoms continue had gonorrhea and have been treated may to provide fewer symptoms so that it can for more than a few days after receiving get infected again if they have sexual contact survive longer. treatment, he or she should return to a with a person infected with gonorrhea. Most of the time, a urine test can doctor to be reevaluated. Any sexually active person can be at risk of be used to test for gonorrhea. However, if a Experts now say the best way to getting infected with the disease. person has had oral and/or anal sex, swabs reduce the risk of even greater resistance Some men with gonorrhea may be used to collect samples from the developing - beyond the urgent need to may have no symptoms at all. However, throat and/or rectum. In some cases, a swab develop effective new drugs - is to treat common symptoms in men include a may be used to collect a sample from a man’s gonorrhea with combinations of two or burning sensation when urinating, or a urethra or a woman’s cervix. more types of antibiotic at the same time. white, yellow, or green discharge from the Gonorrhea can be cured with This technique is used in the treatment of penis that usually appears 1 to 14 days after the right treatment. It is important to some other infections like tuberculosis in infection. Sometimes men with gonorrhea take all of the medication prescribed to an attempt to make it more difficult for the get painful or swollen testicles. bacteria to learn how to conquer the drugs. Most women with gonorrhea If a person has been diagnosed do not have any symptoms. Even when and treated for gonorrhea, he/she a woman has symptoms, they are should tell all recent anal, vaginal, often mild and can be mistaken for a or oral sex partners so they can see a bladder or vaginal infection. The initial doctor and be treated. This will reduce symptoms in women can include a the risk that the sex partners will painful or burning sensation when develop serious complications from urinating, increased vaginal discharge, gonorrhea and will also reduce the or vaginal bleeding between periods. person’s risk of becoming re-infected. Women with gonorrhea are at risk of A person with gonorrhea and all developing serious complications from of his/her sex partners must avoid the infection, even if symptoms are having sex until they have completed not present or are mild. their treatment for gonorrhea and Symptoms of rectal until they no longer have symptoms. infection in both men and women Latex condoms, when used may include discharge, anal itching, consistently and correctly, can soreness, bleeding, or painful bowel reduce the risk of getting or giving movements. Rectal infections may gonorrhea. The most certain way to also cause no symptoms. Infections in avoid gonorrhea is to not have sex the throat may cause a sore throat, but or to be in a long-term, mutually usually cause no symptoms. Before, if a person has urethral gonorrhea, it would be very painful to monogamous relationship with a However, with the new urinate; it is like passing razor blades. Now with the "superbug" strain partner who has been tested and is of gonorrhea, it is not that painful anymore and people with gonorrhea “superbug” strain, the WHO said that sometimes only notice the discharge if they look when they urinate. known to be uninfected. gonorrhea has not only adapted to (Artwork by Antonio Totto Jr.) - o O o -
July - August 2012 I HEALTHbeat 43 Muslim HEALTH
Islamic View on Vaccination by TATO M. USMAN, MD, MPAIM DOH Center for Health Development - Autonomous Region in Muslim Mindanao
On Vaccination activities; and vaccination does not require indigent senior citizens has started with any major lifestyle change, WHO added. a campaign slogan, "Kahit si Lolo at Lola According to the World Health Meanwhile, the Department Kailangan ng Bakuna. Sa Health Center Organization (WHO), immunization is the of Health has been implementing an Pumunta." process whereby a person is made immune immunization program that covers vaccine- or resistant to an infectious disease, typically preventable diseases like DPT (diphtheria, Preventing Disease in Islam by the administration of a vaccine (or pertussis & tetanus) and MMR (measles, vaccination). Vaccines stimulate the body’s mumps & rubella), among others. In Islamic perspective, the Qur’an own immune system to protect the person These vaccines are increasing and and Sunnah (teachings of the Messenger against subsequent infection or disease. recently the immunization program is being of Allah) give guidelines concerning the Immunization is a proven tool for extended to senior citizens by providing promotion of physical health of humans. As controlling and eliminating life-threatening protection against life-threatening diseases such, Muslims are required by Islam to take infectious diseases and is estimated to namely, influenza and pneumococcal all the necessary steps to protect themselves avert between 2 and 3 million deaths each pneumonia. In this connection, DOH against diseases and stay healthy. year. It is one of the most cost-effective issued Administrative Order (AO) No. 2011- Evidently, the Prophet (peace and health investments, with proven strategies 0018 dated November 2, 2011 on the blessings be upon him) is reported to have that make it accessible to even the most implementing guidelines on the provision of said, “He who reaches the morning while hard-to-reach and vulnerable populations. these vaccines to indigent senior citizens. health in his body, safe in his residence and It has clearly defined target groups; it can In the Autonomous Region in having his day’s sustenance, will be as if the be delivered effectively through outreach Muslim Mindanao, free immunization for entire life of this world was granted to him”
44 HEALTHbeat I July - August 2012 (At-Tirmidhi). with that because it is a kind of protection." In one situation, a nomad came to In addition, Imam Ahmad narrated Moreover, Sheikh Ahmad Kutty, the Prophet (peace and blessings be upon that Abu Bakr As-Siddiq said, I heard the a senior lecturer and an Islamic scholar at him) and reported that he had left his camel Messenger (peace and blessings be upon the Islamic Institute of Toronto, Ontario, unleashed in the desert trusting that Allah him) of Allah saying, “Ask Allah for certainty Canada, stated: ”Immunization against would take care of it. The Prophet (peace and and good health for indeed, no one will have possible or future occurrences of diseases blessings be upon him) told him he should a better possession after certainty of Faith does not contravene Muslim’s faith in Ghayb have rather tied his camel first and then put than good health” (At-Tirmidhi). (unseen), as an exclusive knowledge of his trust in Allah.” Shedding more light relative to Allah. Muslim must be fully convinced that Also, even the Ministry of Hajj disease prevention, the late Saudi scholar matters of Ghayb are known only to Allah. At (Kingdom of Saudi Arabia) required all Sheikh `Abdul-`Aziz Ibn Baz (may Allah bless the same time Islam teaches Muslims that visitors from all over the world arriving for his soul), stated: "There is nothing wrong in they must plan and prepare themselves for the purpose of Umrah (minor hajj) and Hajj giving preventive treatment if there is a fear contingences and presumed harm based on (pilgrimage to Mecca) to have a certificate that the disease may occur because of the their understanding of being Sunnat-ullah of vaccination against meningococcal presence of an epidemic or other factors that (laws of Allah) in creation. meningitis. Whereas, travelers arriving from may cause diseases. Also, there is nothing Explicitly, the Qur’an and the the countries known to be infected with wrong with giving vaccines to ward off the Sunnah ruled that the universe functions yellow fever (as shown in the WHO Weekly feared disease, because the Prophet (peace according to the law of causation. Muslim Epidemiological Record) must present a and blessings be upon him) is reported to should not simply wait for the miracles to valid yellow fever vaccination certificate in have said, “Whoever eats seven dates of happen, rather one should make use of accordance with the International Health Madinah in the morning will not be harmed causes to obtain benefits or remove harm. Regulations. by witchcraft or poison” (Al-Bukhaari and In fact, the Prophet (peace and blessings be Therefore, taking all necessary Muslim). This is a kind of warding off a upon him) was always planning in advance precautions to prevent presumed harm problem before it happens. So if there is a for every move; he was a real strategist as a or diseases like vaccination is perfectly fear of sickness and a person is vaccinated leader, and this in no small measure stands permissible (and even encouraged) in Islam. against an infection that is present in the as the cause of his astounding success in his Allah Almighty knows best. land or elsewhere, there is nothing wrong mission. - o O o - FACEbeat AGING: A State of Mind Photo floats in the Internet
July - August 2012 I HEALTHbeat 45 BLOOD donation Red July in Central Luzon by LENI P. CARREON DOH Center for Health Development - Central Luzon
Pampanga Governor challenged local government Lilia Pineda and Dr. Leonita officials and health workers Gorgolon, director of the to organize community-based Department of Health - Center blood donor registry wherein for Health Development (CHD) in every barangay has a list of Central Luzon, spearheaded the individuals who are registered kick-off activity and celebration as blood donors complete with of the Blood Donors Month in their ABO group and RH type July. This provided an opportunity and other contact information. for more Pampanguenos to These potential donors will serve voluntarily donate blood as well as walking blood donors who as for them to continuously are ready to donate blood when advocate local government needed in the community. She units to strengthen their blood added that health workers should networking system. lead in the advocacy work and Gorgolon emphasized recruitment of donors while the that Central Luzon is constantly Local Blood Council will serve as a doing its best to ensure governing body. blood safety and availability Gorgolon even cited guaranteeing its quality systems provisions of the Republic Act starting from the transfusion No. 7719 where it stated that process of donors to the follow-up adequate, safe affordable and of the recipients of transfusion. Blood Donors Month celebrations in Central Luzon. equitable distribution of supply Highlighting this year’s blood and blood products kick-off event was the Walk for Life, human the outstanding blood banks nationwide. shall be ensured. In Central Luzon, blood blood formation, dance exercises and the Ong shared their best practice from donor transfusion is commonly used in pregnancy- releasing of red balloons to honor the recruitment to good manufacturing practice related complications and severe childhood invaluable contribution of voluntary blood to good hospital practice and clinical anemia. She added that blood supply should donors who are co-partners in saving human approach. Ong also emphasized that they also be considered during disasters and lives. A ceremonial signing of the Pledge of make sure that they give the right blood to emergencies. Commitment among different partners and the right person at the right time. She added CHD Central Luzon continues local leaders completed the event. that their approach may look simple but to enhance partnership with DOH Gorgolon also acknowledged the the most important factor they consider is hospitals, Philippine National Red Cross, presence of Dr. Remedios Ong, pathologist the frontline health service providers in the local government units and other health from Angeles University Foundation who hospital who serve with commitment and partners like schools, media, police, and talked about quality management of blood political conviction. private companies, towards comprehensive services in their Level IV hospital which Hand in hand with quality blood networking system leading to sustainable is now recognized by the DOH as one of service in the hospital, Gorgolon also blood supply.
46 HEALTHbeat I July - August 2012 DISASTER RISK reduction The Need for SPEED In observance of the National Ona added that SPEED serves as an DOH and the World Health Organization (WHO) Disaster Risk Reduction Month, the alert warning tool for the health emergency with support from Australia, USA, Finland and Department of Health through the Health managers in providing appropriate and timely Spain governments and aid agencies. Emergency Management Staff (HEMS) held interventions to address prevailing health a nationwide simulation of the Surveillance conditions, thus preventing the occurrence Be Part of SPEED in Post Extreme Emergencies and Disaster of possible outbreaks and controlling (SPEED) on July 17-19. complications. Individuals and institutions can be SPEED is an early warning Also part of this innovative a partner with the DOH and help SPEED save surveillance system that monitors health reporting system is the SPEED Health Facility more lives through initiatives like: conditions (both communicable and non- Code Book which contains a set of codes Policy Support. Implement as communicable), injuries and health trends developed and assigned to each health facility part of the LGU's early warning system, in using web-based software. It is a powerful tool that will enable the SPEED system to identify accordance with the health information for health managers to get vital information the origin of a report. To date, 11,395 health management provisions of Repbulic Act for appropriate and timely response during facilities have been coded, which include main 10121 (The Philippine Disaster Risk Reduction emergencies and disasters. It likewise enriches health centers, barangay health stations, and Management Law) to hasten the the DOH's health emergency preparedness, government and private hospitals, and some determination of health conditions and needs management and response. identified evacuation centers. The Code Book of their disaster-affected constituencies; Health Secretary Enrique T. Ona serves as a reference material that provides Infrastructure Support. Improve said that the simulation exercise is one of the quick and ready access for health personnel telecommunication connectivity of barangays, biggest exercise that will test the viability who will use the SPEED system. municipalities, provinces, and regions; of the SPEED system as well as the reporting To date, SPEED has provided Equipment Assistance. Provide ability of health workers using short messaging valuable health data during and after the the necessary communication hardware for service in evacuation centers, hospitals, and eruption of Mt. Bulusan in Sorsogon, floodings SPEED implementation especially in health other health facilities. Likewise, this will also in Northern Mindanao, onslaught of typhoons centers and other health facilities; and test the ability of its regional health personnel Juaning, Pedring, Quiel and the most recent Human Resource, Advocacy and in the validation of health data from the local tropical storm Sendong in Cagayan de Oro and Training Support. Support training programs level and transform these into actionable Iligan Cities and actual use of SPEED in disaster-prone and information. SPEED is a collaborative effort of the disaster-affected areas
LEFT: How SPEED works. Legend: MHO = Municipal Health Office; CHO = City Health Office; PHO = Provincial Health Office; LGU = Local Government Unit; CHD = Center for Health Development or the DOH regional office; signifies the sending of Immediate Notification Alert when health conditions with high epidemic potential are seen in health facilities. RIGHT: SPEED nationwide simulation exercise. (Photo by Paking Repelente)
July - August 2012 I HEALTHbeat 47 HEALTH partner Batangas TREAT by DONATO DENNIS B. MAGAT HEALTHbeat Staff In terms of providing services to turned over to the BCFS by Mayor Eduardo the people, it is a fact and many would agree Dimacuha of Batangas City. that government cannot do it alone. Also, “Clearly, the involvement of TREAT because of rapid increasing population, in our community is very much welcome migration, and modernization, the as it bridges the gap in the province’s government needs all the support it response to any disaster, service can get from other sources. delivery, and mobilization,” Mayor At the Department of Dimacuha said. Health, since the start of the Aquino He noted that TREAT played a administration, public-private pivotal role during the January 2011 partnership has been a primary rescue and retrieval operation of a strategy in improving services and vehicular accident involving a car, bus upgrading people’s health. and jeepney resulting to six fatalities Another avenue of extending from the crushed passenger jeep. It also the reach of the government to its people assisted the BFP, the Department of Social is volunteerism. In today’s fast-pace kind of Welfare and Development, and other non- living, many would wonder if volunteerism government organizations (NGOs) and still exists. While it is true that the spirit of was affiliated with the Batangas Emergency coordinated with different private school Bayanihan is innate in every Filipino’s heart, Brigade Deployment, an auxiliary program and government offices for the 1st National the need to work double time in order of the BCFS. Simultaneous Earthquake Drill on February to survive prevents every Juan to render In December 2008, about 100 2011, and organized a motorcade for the volunteer work in their community. TREAT members underwent the Vehicular 2011 Fire Prevention month with the theme, The province of Batangas is proud Accident Response and Victim Extrication “Kahandaan Sa Sunog... Tungo Sa Kaunlaran”. to announce that the spirit of volunteerism Training under the Vehicular Accident Other activities the TREAT is still very much alive through the Trisikelion Deployment program of the BCFS. As participated in were OPLAN Balik-Eskwela Rescue and Emergency Assistance Team a result of the group’s participation, inspection of about 12 colleges and (TREAT). TREAT was awarded by the Bureau of Fire universities for the school year 2011- TREAT started in mid-2007 when Protection (BFP) Region IV-A a plaque for its 2012 where TREAT members assisted BFP about 10 members of the Tau Gamma Phi involvement in Fire Prevention Month. personnel in the cleaning and flushing of volunteered as fire brigade at the Batangas In August 2009, TREAT again canals, and inspection of electrical wirings City Fire Station (BCFS) under City Fire was awarded a plaque of recognition in said schools, evacuation and rescue Marshal CINSP Romel Tradio. In May of by the Department of Interior and Local operations in flooded barangays of Pallocan 2008, TREAT’s membership rose to 44 and Government for its invaluable support to the West, Gulod Labac, libjo, Sta Clara, and Sta underwent Basic Fire Brigade Training. BCFS during the anniversary celebration of Rita Ilaya, clearing and cleaning operations Since then, the group actively participated the BFP at the national headquarters. of esteros, drainage, canals, and ditches in every fire prevention activity and In January 2010, a fire-rescue van in Barangay Sta Clara, Batangas City, emergency response efforts of Batangas and with the TREAT and Tau Gamma Phi logo was participated in Alay Lakad 2011 along with
48 HEALTHbeat I July - August 2012 Some of the drills and training programs TREAT members joined to hone their skills in order to be more equipped and relevant to the demands of the times. (Photos courtesy of TREAT)
NGO’s, local government, and private offices and OPLAN “Iwas Paputok, Sakuna at Sunog” stressed that such accomplishments were for the education of indigenous children of from 28 December 2011 to 1 January 2012. worth emulating. He added that TREAT will Batangas. Batangas City Fire Marshal continue to upgrade its skills in order to be TREAT also joined in the OPLAN Superintendent Romel Tradio expressed his more equipped and relevant to the demands Yuletide Fire Safety from Christmas last 2011 satisfaction with TREAT’s involvement and of the times. In Memoriam
JUAN M. LOPEZ, MD, PGradDipPH, MPH June 21, 1959 - July 3, 2012
Director of the Philippine National AIDS Council Secretariat, former Chief of Applied Public Health Division of the National Epidemiology Center, and Founding President of the Unyon ng mga Kawani ng Kagawaran ng Kalusugan Sentral (UKKKS).
July - August 2012 I HEALTHbeat 49 SAbeat
Tattoo Ina at Anak Facebook is Life
FRANK: Hala! Pare, paparating na asawa LUZ: Hoy bata ka! JEAN: Anak! Takbo na nasusunog na mo at papauwiin ka na. KRYSTAL: Hoy? Bata ako? Saan ako galing? bahay natin! ERNIE: Wala yan! Kapag ipinakita ko ang Alas dos na ng madaling araw BABY: Wait lang 'Nay, mag-post muna tattoo ko sa dibdib, uuwi na yan. ah? Katanda ko na, wala pa akong ako sa FB na nasusunog na bahay (At ipinakita nga sa Misis ang isip? Hindi ko ba alam na nag- natin! tattoo at bigla itong umalis nang aalala na si Nanay at Tatay? JEAN: Aba! Dalian mo't magla-LIKE pa walang imik.) Walang hiya akong bata? Hala ako! FRANK: Astig ka, 'Pre. Bilib ako sa 'yo! sige, lumayas na 'ko at huwag na JUN: Hoooy! Dalhin n'yo at baka Patingin nga ng tattoo mo... akong babalik?!? masunog 'yang computer! (Ang nakalagay sa tattoo ay: LUZ: Grabe ka naman, anak. Itatanong Magko-COMMENT pa ako! "Mauna ka na boss, susunod na ko lang naman kung kumain ka ko.") na?!? Cellphone KRYSTAL: Sorry 'Nay . Na-excite lang po ako. Balita GLEN: ‘Tol, anong cellphone mo? Gising DENNIS: Apple, ‘tol. Ikaw? EVELYN: Ano itong nabalitaan kong may GLEN: Blackberry. kabit kang 18 years old, ha?!? TITSER: Denpot! Gumising ka! DENNIS: Eh, ikaw, Philip? JOEL: Huh? Ano ka? Huli ka na! DENPOT: Ma'am?!? PHILIP: Cherry lang. Ikaw ba, Ariel, ano? 23 years old na kaya siya TITSER: Palagi nalang kitang ginigising ARIEL: (Naku, ano kaya isasagot ko. Puro ngayon! sa klase ko! prutas ang brand ng cellphone DENPOT: Okay lang po yun, Ma'am. Ikaw nila...) Ano... eh... kuwan... Bilib din naman po ang nagpapatulog BANANA! sa akin eh! TITSER: Paulo, paano mo nagawa Dagdag na ma-perfect ang exam mo, Contribution ha?!? DELIA: Honey, gusto mo bang PAULO: Bilib ka na naman sakin Ma'am?!? IKING: What can you contribute to our magpadagdag ako ng boobs? Mata ko pa lang ang ginamit ko company? OSCAR: Huwag na, sweetheart. Tama d'yan. Paano pa kaya kung pati BLESSY: Ay, ganito pala dito sa kumpanya na sa akin 'yung dalawa. utak ko na?!? n'yo... may ambagan!?!
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50 HEALTHbeat I July - August 2012