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Goodbye Tigdas 5 Look Up to Statistics That Roar 12 Almost 5,000 New Cases of HIV/AIDS in 2013 15 5 Harmful Use of Alcohol 16 Smoking Cessation Clinics 19 16 Graphic Health Warnings Now 22 Health is On the Way 25 Top 10 Stories on Kalusugan Pangkalahatan 30 "The Doctor is In" Gets an Anak TV Seal 35 DOH-wide ISO 9001:2008 Certification 37 Innovating CSC-ARMM Form 211 39 12 Facts About Aflatoxin 41 Tips on Healthy Eating 42 This Page is On Fire 45 25 Burn 46 Severe Heat 47 Under My Umbrella 48 Swimming in Polluted Waters 49
jokes n'yo 37 37 stress RELIEF 43 KALAbeat 44 laughter HEALS 50 SAbeat DEPARTMENT OF HEALTH - National Center for Health Promotion 2F Bldg. 18, San Lazaro Compound, Sta. Cruz, Manila 1003, Philippines I Tel. No. (63-2) 743-8438 HEALTHbeat Website: www.healthbeat.com I Facebook: www.facebook.com/DOH.HEALTHbeat.ph I Email: [email protected] Throwback Tigdas THROWBACK TIGDAS, this is how we paraphrase Jessica Soho's commentary in her State of the Nation news program on GMA News TV describing the measles outbreak that was hogging the headlines and competing with fireworks-related injuries at the end of the 2013 and onto the first weeks of the new year. Throwback, meaning a sudden reminder of the past, fits measles to a T. Measles is one of the childhood diseases that the country wanted so badly to be eliminated as early as 2008, but has been reset to 2017. Measles immunization which is given to a child at age 9 to 11 months is the parameter to become a fully-immunized child. And since the schedule of measles immunization comes much later than the rest of the immunization for other childhood diseases, mothers and caregivers tend to forget or take for granted its importance. Moreso, since it is an injectable immunization it takes a trained medical staff to give it and many children are often very afraid to take it. Mind you, we are not blaming mothers and children, we are just stating some of the reasons why Editorial Board measles immunization coverage is still very low despite the availability and accessibility of Ivanhoe C. Escartin, MD measles vaccines in health centers nationwide. Rosemarie G. Aguirre Chief Editors Anthony R. Roda You may want to disagree but the expanded programme on immunization (EPI) is what made May Elenor R. de Guzman the Department of Health popular and closer to the mind and heart of the people beginning Managing Editor Donato Dennis B. Magat in the post-Martial Law era. The "Iligtas si Baby sa Tigdas" campaign in the late 1980s Staff Writers Elizabeth G. Mascareňas used the social marketing approach in communicating government programs. The "Oplan: Glen S. Ramos Alis Disease: National Immunization Days" in the early 1990s used the social mobilization approach to rally local government units and all sectors of society to save children from Photographer Paquito P. Repelente preventable childhood diseases. It became the benchmark of all health campaigns in the Cover Design Diosdado G. Angeles, Jr. country and the best practice of EPI implementation in Asia and even in the world. Cover Photos Frederick C. Pereňa Maricel Castro/WHO Through the years, the DOH has institutionalized routine immunization in all health centers. It is also prompt in providing immunization services in evacuation centers during disasters Graphics Design Rhoderic N. Domingo and other emergencies. Yet measles coverage remained low in many areas to the point Contributors (Words) Neil Bryan S. Hipolito of experiencing outbreaks. If there is one good thing that happened during the measles Lizelle Christine F. Jusayan outbreak, it is the fact that many of the new generation mothers became fully aware of the Tato M. Usman, MD importance of immunization. Hopefully, the national and local health systems will not fail in (Photos) Romeo S. Caparas providing the most basic services and education. Finally, just to rub it in, we hope that at least Joerem P. Ceria P1 billion annual allocation of Sin Tax revenues will go to disease prevention through health Clarence Damasco promotion. Riza San Juan Circulation DOH-NCHP Production, - The Chief Editors Dissemination & Collection Unit
FOR EDUCATIONAL PURPOSES ONLY. NOT FOR SALE. Opinions expressed in this publication do not necessarily represent those of the DOH. The mention of specific companies or of certain manufacturer’s products does not imply that they are endorsed or recommended by the DOH in preference to others of similar nature. Articles may be reproduced in full or in part without prior permission, provided credit is given to the DOH for original pieces. A copy of the reprinted or adapted version will be appreciated. Articles, artworks, photographs, caricatures, letters and other contributions are most welcome. Materials will be edited for clarity and space. Unsolicited manuscripts will not be returned. Contributors must indicate their names and addresses.
4 HEALTHbeat I January - February 2014 Outbreak! Precautionary notices were sent report an increase in the number of measles to communities through barangay health cases – Central Visayas, Eastern Visayas, Well, what do you know? For the workers. Measles warnings were aired by Northern Mindanao and the Caraga region first time in recent memory, a health issue media and urged residents to bring children in Mindanao. other than firecracker/firework-related aged 9 months to 12 years old for vaccination The NCR had the most number injury shared the limelight as a year-ender- to the nearest health center. of cases with 744. Measles outbreak was year-opener Department of Health concern: And as predicted, measles cases declared in the following Metro Manila areas: MEASLES. in the region burgeoned to more than a Quiapo, Sampaloc, Tondo, Binondo, Sta. Cruz, In October 2013, The regional thousand per cent. The DOH-NCR instructed Port Area and Sta. Mesa in Manila; Dagat- epidemiology surveillance unit (RESU) of the the deployment of teams of nurses to assist dagatan and Bagong Barrio, in Caloocan DOH-National Capital Region (NCR) reported in evaluating patients and provide the City; Talon 2, Talon 5 and Pamplona Uno in an increasing number of measles cases in necessary vaccinations to prevent further Las Piñas; Longos and Tonsuya in Malabon; nine cities of Metro Manila. The DOH-NCR transmission of the disease. But the numbers Alabang and Putatan in Muntinlupa; North immediately warned local health authorities kept on rising. Bay Boulevard South in Navotas; Moonwalk and directed them to strengthen the routine On January 4, 2014, the DOH and Don Bosco in Parañaque; Bagong Tanyag immunization in their respective areas to declared an outbreak of the disease in in Taguig; and Ugong in Valenzuela counter the increasing trend of measles Metro Manila and other parts of the country. By this time, the DOH appealed cases. Health Assistant Secretary and Director of to parents to have their children vaccinated In November, Director Eduardo National Epidemiology Center, Dr Enrique against measles. Health Secretary Enrique T. C. Janairo ordered the replenishment of A. Tayag, reported that from January 1 to Ona, however, reiterated that there was no measles vaccines in all health facilities in December 14, 2013, there were already reason to be scared, or to be too concerned. Metro Manila in any instance that measles 1,724 confirmed measles cases nationwide He emphasized the importance for parents cases continued to rise and pose a threat of with 21 deaths. He added that among the to take a good look at their children always, an outbreak. 17 regions in the country, only four did not so that when symptoms of measles appear,
January - February 2014 I HEALTHbeat 5 the child could be brought to the hospital or health center. In the final tally for 2013, a total of 6,497 suspect measles cases were reported nationwide, and 2,232 were classified as confirmed measles cases, including 23 deaths. NCR had the highest number of cases at 1051 (47%), followed by Southern Luzon with 526 (24%) and Western Visayas with 306 (14%) cases. During the weeks of the measles outbreak, the media were reporting a new strain of the measles virus. The DOH was quick to assure the public that there was no new strain, citing the findings of the Research Institute for Tropical Medicine. A Filipino hip hop dancer who had flu- like symptoms on the day of the dance competition in Australia was also reported to have infected at least 14 people there. Squeezing the issue even further in the news were opinions on how the DOH was not handling the outbreak right and questions on why measles cases escalated despite the availability and accessibility of the vaccines. As ASec Tayag pointed out, “Vaccines will not save lives, vaccination will.”
Flashback
The Expanded Programme on Health Secretary Enrique T. Ona (left) performs measles immunization together with Health Assistant Immunization (EPI) started in 1976 with Seretary Enrique A. Tayag (right) and World Health Organization Representative to the Philippines Dr. Julie Hall (center back) during the press conference to announce the "Goodbye Tigdas" campaign. the aim of making every Filipino child a fully (Photo by Paking Repelente) immunized child (FIC). In 1986, to reach the Universal Child Immunization goal, one of child's first birthday.(Note that Hepatitis B within 24 hours of birth.) the four major strategies the DOH explored vaccine was introduced and made available in Measles immunization has always was eliminating measles by 2008. the EPI since 1992 to only 40% of the infants. been the most crucial and problematic in During these times, the standard insufficient funds limited the immediate full achieving the country’s goal of at least 90% routine immunization schedule for implementation of the Hepatitis B vaccination. FIC. Measles vaccine is the last and given way infants adopted in the Philippines was to However, the enactment of Republic Act No. behind other vaccines in the immunization provide maximum immunity against six 10152 otherwise known as the “Mandatory schedule at 9 – 11 months old. Parents vaccine-preventable diseases – childhood Infants and Children Health Immunization and caregivers have the tendency to forget tuberculosis, diphtheria, pertussis, neonatal Act" in June 2011 provided for all infants to be or take for granted the importance of this tetanus, polio and measles – before the given the birth dose of the Hepatitis-B vaccine Please turn to page 9...
6 HEALTHbeat I January - February 2014
...Continued from page 6 vaccine, however, it takes a different strategy the door-to-door immunization approach, vaccine. because a trained medical staff is required to meaning medical staff went to houses and In 1988, measles was the first administer the injection. schools to vaccinate target children against DOH campaign in the post-Martial Law era By this time, routine immunization measles. Special immunization activities for that used the social marketing approach to has been institutionalized and the steady children were also being conducted during public information and health education. supply of the vaccines in all health centers outbreaks and as a preventive measure in “Iligtas si Baby sa Tigdas,” became the nationwide was established by the DOH. evacuation centers during disasters and slogan to motivate parents to take their From time to time, the DOH needed emergencies. children to their nearest health center for to conduct nationwide supplemental The first dose of the measles free immunization. Wednesday has been immunization days and even extending to vaccine is given to children aged 9 to 11 designated as an immunization day. months, especially for measles, to reduce months, while a second or booster dose is In 1992, the DOH committed the number of children at risk of getting given to children aged 12 to 23 months. to conduct National Immunization Days the infection which has accumulated over However, vaccination of children aged 6 annually for three years to accelerate the the years because of low immunization months old is recommended for places with elimination of polio as well as to improve coverage in some areas as well as the need an outbreak. EPI coverage reach the country’s FIC targets. to eliminate measles in the country by 2008, With all these efforts, several Social mobilization and recruitment of an ambitious target that the Philippines set children are still unvaccinated, and the goal 400,000 volunteers in 64,000 vaccination ahead of its neighbors in the Western Pacific to achieve "herd immunity" to measles has points were utilized in this grand health Region. not been reached. Herd immunity is when campaign which became the first in Asia. There was the “Iwas Tigdas” in 1998; more than 95% of the targeted children This approach could be done for oral polio “Ligtas Tigdas” in 2004, “Knock-Out Tigdas” are vaccinated, and it is very diffiicult to vaccine because vaccination can easily be in 2007, and “Iligtas sa Tigdas ang Pinas” achieve because during national or local done by non-medical personnel. For measles in 2011. All these measles campaigns used government vaccination drives, certain
In early January, the Department of Health and local government units stepped up vaccination activities to prevent further outbreak in Metro Manila. Health Undersecretaries Janette L. Garin and Teodoro Herbosa are shown here leading a vaccination drive . (Photo by Paking Repelente)
January - February 2014 I HEALTHbeat 9 places are not being covered, can be transmitted by an infected including areas with armed conflicts, person from four days prior to the slums, new settlements and even onset of the rash to four days after the private subdivisions and high-rise rash erupts. condominiums. In fact, the country's The first sign of measles is usually target to eliminate measles by high fever which begins about 10 to 2008 has been postponed to 2017. 12 days after exposure to the virus, Measles elimination means that in and lasts four to seven days. Other a population of 100 million, like the symptoms include runny nose, cough, Philippines, the laboratory-confirmed red and watery eyes, and small white cases should not exceed 100 people. spots inside the cheeks can develop With large population in the initial stage. After sever several movement especially in Metro Manila days, a red rash erupts, usually on the and other big cities, a mix of vaccinated face and upper neck. Over about three and unvaccinated population coexist. days, the rash spreads, eventually A measles patient can infect several reaching the hands and feet. The rash other unvaccinated children and lasts for five to six days, and then adults, thus outbreaks are likely to fades. On the average, the rash occurs occur. In the recent outbreak in Metro within a range of seven to 18 days. Manila, babies under 9 months old The most serious measles-related were reported in media getting complications are severe respiratory measles. In these cases, exclusively infections such as pneumonia, severe breastfeeding babies immediately Babies should be breastfed immediately upon birth to give them diarrhea and related dehydration, upon birth and up to six months is an immune boost from their mothers’ colostrum, which is only encephalitis or an infection that very important to boost protection produced at the first feed. Then, they should be breastfed as often causes brain swelling, ear infections, against many childhood diseases. as they want to for the next several months, and not be given blindness and even death. Compli- any other food or drink. This is the best all-natural way of giving If there is one good thing children protection against many diseases that stalk them in cations are more common in children that happened in the outbreak, schools, playgrounds, and in other public places. Children should under the age of five, or adults over it is the fact that many parents also be given the appropriate vaccinations for their age to ensure the age of 20. realized the importance of measles further immunity against other dangerous pathogens they may No specific antiviral treatment immunization that many of them encounter later in their young lives. (SOURCE: WHO) exists for the measles virus. Severe are seen voluntarily submitting their complications can be avoided children for it. health care. Women infected while pregnant through supportive care that ensures are also at risk of severe complications and good nutrition, adequate fluid intake and Spread the Knowledge the pregnancy may end in miscarriage or treatment of dehydration with the World Not the Virus preterm delivery Health Organization-recommended oral Measles is caused by a virus of the rehydration solution. This solution replaces Measles is a highly contagious, paramyxovirus family. The measles virus fluids and other essential elements that are serious disease caused by a virus. It remains normally grows in the cells that line the lost during diarrhea or vomiting. Antibiotics one of the leading causes of death among back of the throat and lungs. The virus is should be prescribed to treat eye and young children globally, despite the spread by coughing and sneezing as well as ear infections, and pneumonia. Children availability of a safe and effective vaccine. close personal contact or direct contact with diagnosed with measles should also receive As high as 10% of measles cases result in infected nasal or throat secretions. The virus two doses of vitamin A supplements, given death among populations with high levels remains active and contagious in the air or 24 hours apart. This treatment restores low of malnutrition and a lack of adequate on infected surfaces for up to two hours. It vitamin A levels during measles that occur
10 HEALTHbeat I January - February 2014 even in well-nourished children as well as up campaign aimed at preventing measles time with available health center staff. helps prevent eye damage and blindness. outbreaks and at the same time vaccinating More importantly, mothers can also seek Vitamin A supplements have been shown to every child who missed their routine measles other health services for their families. reduce the number of deaths from measles immunization which means for two doses of Participating LGUs had the option to deploy by 50% the measles vaccine - first at between age 6- teams to areas where turnout at health Routine measles vaccination for 11 months and second at 1 year. centers was low. The DOH also reiterated children, combined with mass immunization Dubbed as "Goodbye Tigdas," the that the vaccines are provided to children for campaigns in countries with high case and campaign initially covered over 2 million free as it enjoined health centers to refrain death rates, are key public health strategies children aged 6 months to 3 years in Metro from asking for donations for immunization to reduce measles deaths. The vaccine has Manila and seven nearby provinces, namely: services not only for measles but also for been in use for 40 years. It is safe, effective Cavite, Laguna, Batangas, Rizal, Quezon, other vaccine-preventable diseases. and inexpensive. The measles vaccine is often Bulacan and Pampanga. These areas were Secretary Ona announced that incorporated with rubella (German measles) targeted because of increasing number of a nationwide mass measles and oral polio and/or mumps vaccines in countries where measles cases or deaths among children vaccination campaign for 13 million children these illnesses are problems. It is equally 3 years and under, contiguity with areas aged 9 months to 4 years old is slated in effective in the single or combined form. with reported outbreak (several areas in September 2014 or even earlier. Metro Manila), several communities with Fast Forward low vaccine coverage, high population ----- density, and high population mobility. by ANTHONY R. RODA From January 23 to February 3, vaccination is limited at health centers so and GLEN S. RAMOS 2014, the DOH staged an expanded catch- that local government units can maximize HEALTHbeat Staff
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January - February 2014 I HEALTHbeat 11 iwas PAPUTOK
(Photos by Paking Repelente and Romy Caparas) Look Up to Statistics that Roar by ELIZABETH G. MASCAREÑAS, RN, MPH HEALTHbeat Staff
Did this, done that. Whatever has explored everything, yet many of the emergency services, doing research and the public, netizen and media commented needed measures are beyond its control. surveillance, providing information, and yes, on how the Department of Health Nevertheless, the DOH has not stopped educating while entertaining the public just handled the Iwas Paputok (Fireworks coordinating with various stakeholders, to make the longest and merriiest Yuletide Injury Reduction) campaign in 2013, it pushing laws and policies, administering season in the country safe.
12 HEALTHbeat I January - February 2014 Target the Children of maimed hands or loss of fingers to make we can pretty much avoid." them stop from using paputok, the DOH Every year, the 6-15 years old age decided to scale down the use of gruesome Roaring Statistics group comprises the majority of injuries images in light of the recent calamities that due to paputok (ffireworks/firecrackers), devastated the country, particularly the From December 21, 2013 - and they are the main target of the DOH Zamboanga crisis and the massive flooding January 5, 2014, the DOH Fireworks-Related campaign. in Olongapo City in September, the 7.2 Injury Surveillance collected data from In a desperate move to lessen magnitude earthquake in the Visayas in 50 sentinel hospitals composed of DOH, fireworks related injuries particularly October, and the most recent, Super Typhoon local government and private hospitals among children, the DOH launched the Yolanda affecting over 9.6 million people in throughout the country. As the data came Iwas Paputok campaign on the first week eight regions of the country. in, the DOH noted and expected that the of December 2013 with Health Assistant Thus, the campaign carried number of paputok injuries would rise. Tayag Secretary Enrique A. Tayag dancing to the the theme, “Maging Ligtas Ngayong who is also the DOH chief epidemiologist tune of Katy Perry’s “Roar.” The DOH wanted Kapaskuhan, Mga Biktima ng Kalamidad said, “People are in a festive mood towards to spread the message that instead of using Handugan.” Ona opined, "When again many the celebration of the New Year, reeling paputok, the public should dance in home or children get maimed from firework-related from the somber mood after the series of street parties, among other safe alternative injuries, it becomes another disaster which calamities that hit the country and so this merrymaking activities. ASec Tayag’s talent in dancing became public in 2011 for Iwas Paputok that his “Roar” dance, although still very much highly anticipated, was not a surprise anymore. What became unprecedented in last year’s campaign was Health Secretary Enrique T. Ona’s guesting in “The Ryzza Mae Show” on GMA 7 on December 19. Ryzza may rightfully claim that she is the most popular child star of this generation, knowing that this “Aleng Maliit” has a great number of children and even adults following her on television, commercials and lately, movies. The health chief saw the opportunity to guest in Ryzza’s TV show to encourage children not to use or even touch paputok, and instead use the dependable “torotot” (party horns) or watch community fireworks displays. Although the October 2013 survey conducted by the DOH-National Epidemiology Center among Grades 1-5 in public and private schools in the National Capital Region (NCR), Region 1 and Region VI (the three regions with the highest paputok-related injuries in 2012) revealed In an unprecedented move for the Iwas Paputok campaign, Health Secretary Enrique T. Ona guests in that schoolchildren still prefer gory images Aleng Maliit's “The Ryzza Mae Show” featuring on GMA-7. (Photos by Paking Repelente)
January - February 2014 I HEALTHbeat 13 is one of the reasons why we are predicting ingestion – a 1 year old and a 6-year old who of both hands and enucleation of his left 50 to 80 new firework-related injuries every ingested Popup and luces. There were 19 eye, while a 12-year old boy died because hour." cases of stray bullet injuries, which is lower of a severe head injury. The family donated Towards the New Year's eve compared to 2012 with 25 cases. the boy's kidneys to an ailing diabetic. Ona celebration, the DOH shifted its messages Of the total, 997 (97.9%) were called this "an act of uncommon heroism and showed in media the various medical paputok injuries, and 818 (82%) were males. and kindness." instruments to treat injuries and even cut Ages range from 1 yr to 74 yrs (median=14 Based on the statistics, Ona bones. The DOH welcomed moves of local yrs). A total of 250 (25%) cases were children observed that the number of injuries could government units (LGUs) to enforce total ban less than 10 years old, and 376 (38%) were have been reduced if fewer revelers used of use of paputok by individuals, especially caused by the banned piccolo. The other piccolo. Because piccolo has consistently children and instead limiting its use to fireworks that cause the most injuries were been the top firework that caused these community firework display or the so-called unknown firecrackers 121 (12%), Kwitis injuries for so many years now, he urged LGUs "Just Watch, Do Not Touch" approach. 105 (11%), Five star 46 (5%) and Pla-pla 45 to review their procedures on enforcement And the final countdown revealed (5%). of their existing ordinances. For its part, the the number of firework related injuries in The DOH also reported 843 (85%) DOH has readied its draft bill on paputok 2013 was higher than in 2012. As of 6:00 blast injuries without amputation compared and is looking for proponents in the newly- am of January 6, 2014, the DOH reported a to 753 (83%) in 2012. There were 25 (3%) installed 16th Congress. total of 1, 018 paputok-related injuries. This amputations this year compared to 34 This draft bill will absolutely ban is 73 (8%) cases higher than the five-year (4%) last year, and 147 (15%) eye injuries the use of paputok in residential areas, in (2008-2012) average and 87 (9%) cases compared to 137 (15%) last year. Also, there order to safeguard the safety and health of higher compared to the same time period was proportionately less by-standers who the population in the community, and allow last year. Majority (587 or 58%) of the had injuries among those who had injuries LGUs to identify specific non-residential cases were from NCR, followed by Region in 2013 (363 or 36%) compared to 450 or areas in the barangay wherein the use of 4-A (CaLaBaRZon) with 80 (8%) cases and 50% in 2012. paputok will be contained, such that said Region 6 (Western Visayas) with 73 (7%). One death was reported. The most activities will be regulated and controlled by In NCR, Manila 215 (37%), Quezon City 130 serious injuries incurred by the victims were the government authorities to avoid possible (22%), Mandaluyong 45 (8%), Marikina 37 that of the two boys from Balong Bato, paputok-related injuries. (6%) and Las Piñas 36 (6%) reported the Quezon City, who were gathering used Moreover the draft bill calls for most number of injuries. firecracker powder that suddenly exploded the absolute ban on the sale of paputok There were two cases of paputok on them. An 11-year old boy had amputation to children, to prevent them from using firecrackers unsupervised by their parents or guardians, and protect them from potential dangers arising from its use, aside from possible health illnesses they may sustain. All Iwas Paputok efforts have not turned into smoke. As statistics seemed roaring and looking up, most injuries however were relatively milder in 2013. Paputok victims, no matter how small their injuries, were rushing to hospitals for prompt treatment including the anti- tetanus vaccine. There were also fewer injuries among children less than 10 years old compared to previous years. As statistics seemed roaring and looking up, most injuries however were relatively milder in 2013. - o O o -
14 HEALTHbeat I January - February 2014 HIV/AIDS CONTROL Almost 5,000 New Cases of HIV/AIDS in 2013
Although the prevalence of HIV/ cases are 20 - 34 years old. A significant came from the National Capital Region. AIDS in the country is still considered low, number of cases are also reported among The other highest reporting regions were: the Philippine HIV and AIDS Registry for males 15 - 19 years old. CaLaBaRZon (13% or 1,995), Central Visayas 2013 reveals a 69% increase in the newly There were 197 deaths reported (9% or 1,408), Central Luzon (8% or 1,270), reported HIV cases compared to the same in 2013. The annual number of deaths from and Davao Region (6% or 926). The rest of period in 2012. 1984 - 2010 ranges from 2 to 36 cases with the country comprised 14% (2,158) of all From January - December 2013, an average of 14 deaths per year. However, cases. there were a total of 4,814 new cases. For beginning 2011, there was an increase in the The Philippines is one of only two 2012 and 2011, the registry showed 3,152 number of recorded deaths, with 69 in 2011 countries in Asia, and one of seven globally, and 2,239 cases, respectively. In 2013, 94% and 177 in 2012. where the number of new HIV cases has were infected through sexual contact, 6% As of December 2013, there are increased by over 25% from 2001 to 2009. through needle sharing among injecting 5,564 people living with HIV presently on The biggest challenge the country faces drug users, and less than 1% through anti-retroviral therapy (ART). These are the now is to reach the targets of Millennium mother to child transmission. There were combined numbers of adult and pediatric Development Goal No. 6 – halt AIDS with 4,326 male and 214 female infected through patients currently enrolled and accessing zero new HIV infections by the end of sexual transmission. anti-retroviral drugs in the 17 treatment 2015; reverse the spread of HIV/AIDS, and; The new infections are largely hubs or hospitals around the country. This improve the quality of life of people living concentrated among key populations number is not cumulative and it does not with HIV. This means primary prevention with specific risk behaviors, such as include those who already have died, left the and diagnostic and treatment services unprotected male-to-male sex, commercial country, or decided to stop taking ART. to be made available to the most at risk (transactional) sex and injecting drug use. Since 1984 to present, there were population groups, especially in areas with The age group with the most number of 16,516 cases reported. Half (7,622 cases) high incidence of new HIV/AIDS cases.
Number of HIV/AIDS Cases Reported in the Philippines by Year, January 1984 to December 2013 (N=16,516)
January - February 2014 I HEALTHbeat 15 alcohol CONTROL Harmful Use of Alcohol "Drink Moderately or Responsibly" May NOT be the Right Message Anymore by ANTHONY R. RODA, MaHeSoS HEALTHbeat Staff Alcohol and Young People by young people carries particular risk several decades show that alcohol and heart because of the specific effects that alcohol health have a positive relationship. Moderate "I can buy you, your friends, has on their still developing brain. Recent alcohol use may be of most benefit only and this club," allegedly blurted out by an studies have shown that the human brain for older adults or for those with existing intoxicated Anne Curtis who also reportedly does not stop developing at adolescence, risk factors for heart disease, such as high slapped other guests at an upscale club in but continues on in the twenties. cholesterol. However, several current studies Taguig City. Curtis, an endorser of an alcohol The World Health Organization have linked even a little drinking of alcohol brand which is advertised as ideal for mixed (WHO) states that harmful use of alcohol to a higher risk of cancer of the breast, liver, drinking and marketed for the youth, made is closely related to problems of injuries, rectum, throat, mouth, and esophagus. a series of Twitter posts after the incident traffic crashes, risky sexual behaviors and At any age, evidence shows that went viral late last year. She said, "For those unexpected pregnancies. There is also even moderate drinking may cause more who have read about the issue, yes, most of a strong association between alcohol harm than good. And it is clear from research it is true... I had been on the super popular consumption and tobacco and other drug that the strongest predictor of alcohol juice cleanse for 3 days and attended my use among young people. dependence in adulthood is heavy drinking best friends bachelorette that night, had one A lot of factors influence how and during adolescence. too many drink which led to some of these to what extent alcohol affects the brain, unfortunate events. That’s why they say ‘Drink including how much and how often a Addressing the Harmful Use in moderation.'" person drinks, the age at which first drinking of Alcohol by Young People In situations like this, drinking began, the person's age, level of education, moderately or responsibly, the so-called self- gender, genetic background family history The WHO Western Pacific Regional regulation message being proliferated by the of alcoholism, among others. Even moderate Office and the Department of Health- alcohol industry, is emphasized but it hides drinking leads to short-term impairment, as Hong Kong Special Administrative Region the real health concern which teenagers and shown by extensive research on the impact called on a regional meeting to address the young adults usually engage in as part of of drinking on driving. And repeated use of harmful use of alcohol by young people their socialization – binge drinking. It may alcohol has a long-term negative effect on in Hong Kong, China on November 12-14, be defined as consuming five or more drinks memory and learning. 2013. It was attended by 33 delegates from in about two hours for men or four or more In general, there is little awareness 17 countries, including the Philippines. This drinks for women. over the negative effects of alcohol served as a follow-up to the meeting on Binge drinking takes a heavy toll on consumption. It is hardly known for instance "Non-Communicable Diseases Prevention young people.They are at increased risk for that ethanol in alcoholic beverages has been and Control through the Reduction of alcohol-related harm. Alcohol clearly affects identified by the Interagency for Research Alcohol-Related Harm" also held in Hong the brain as drinking results to difficulty in on Cancer (IARC) as a group 1 carcinogen Kong in 2012. walking, blurred vision, slowed reactions, in humans, and this applies a stronger Alcohol consumption among blackouts and impaired memory. Some particular risks associated with drinking by young people is of growing concern people experience these impairments after young people. throughout the Region, and has become the only one or two drinks. Alcohol consumption Numerous studies dating back leading risk factor for disease burden and
16 HEALTHbeat I January - February 2014 injuries. At the regional and global level, deferred as long as possible, preferably WHO recently accorded high priority to the until the age of 21, but certainly not before reduction of alcohol-related harm with the 18. Legislation and its enforcement on endorsement and implementation of the minimum age for alcohol consumption and Global Strategy to Reduce Harmful Use of supply to minors are obvious instruments to Alcohol and the Regional Strategy to Reduce protect young people. Alcohol-Related Harm. Drunk driving control is regarded WHO urged countries to take key to be a relatively easy, achievable and actions, such as increasing taxation and necessary target for action, given also the limiting alcohol marketing and access to fact that alcohol associated road accidents alcohol through age restrictions, with the are a leading cause of death in the 15 aim of reducing drinking and its negative to 29 years old. Evidence as collected on consequences among young people and the the establishment of legislation and its general population. enforcement in some participating countries In many countries represented in showed the ensuing positive impact on the meeting, prices of alcoholic beverages prevalence of road traffic fatalities. have become relatively lower and the The setting up of alcohol-free product more affordable over the past zones in communities or localities is years. Appropriate taxation provides a increasingly being used on behalf of public powerful means of making alcohol action safety, public order and public health. It is sustainable. an effective way to reduce alcohol-related In general, there is poor regulation problems, for example during sports or of marketing of alcoholic beverages in the cultural events, and deserves to be utilized Region; in a significant number of countries more structurally by local governments. there are no legal restrictions at all on In this connection attention needs to be marketing; in other countries the regulation given also to certain settings like schools and control of marketing is left to self and working places that benefit from regulation by the alcohol industry which is a clear “no alcohol drinking” rule. known to be deficient; and in some other In many countries, existing countries, legislation may be present but licensing regulations and systems enforcement mechanisms are not sufficient. need to be strengthened to On the other hand, the alcohol industry maximize their potential continues to establish a positive image for to maintain public safety its products among young people through and public health. Effective increased use of traditional and new media control of density of outlets and as well as sponsorship of sports or cultural opening hours is contributing to events. The participants agreed that the reducing alcohol related problems in ultimate goal must be a complete ban on all communities. Furthermore, licensing is forms of marketing alcohol, as with tobacco an obvious mechanism for the control of products. illicit alcohol. The participants also agreed that The very nature there must be no misunderstanding over of alcohol control requires a drinking among young people, that young multi-sector approach. This is a people should not drink alcoholic beverages. requirement, a challenge, and at the The initiation to drinking must also be same time, an opportunity to join
January - February 2014 I HEALTHbeat 17 forces with institutions beyond health. on its second year of implementation while and control of non-communicable diseases, Young people themselves can be the Anti-Drunk and Drugged Driving with healthy lifestyle, road safety, adolescent powerful partners or initiators for developing its implementing rules and regulation that health and development, substance abuse, protective measures for their own health and took effect on September 21, 2013 would and even mental health. safety when it comes to alcohol consumption still take time before it is fully implemented However, the DOH is missing and the promotion of alcoholic beverages. because the Land Transportation Office will out the right message on the reduction of It is feasible and important to have young need to train police and traffic enforcers on the harmful use of alcohol. In its Pilipinas people’s organizations at community or the use of gadgets like the breath analyzer Go4Health message targetting the youth national level involved as full partners in machines, how to conduct sobriety tests, and and young adults for example, “Go Slow policy development in this area. other protocols in apprehending violators of sa Tagay” or “Drink Moderately” is being the law. communicated instead of "No Alcohol." Alcohol Control Despite these laws, much is still to Moreover, the DOH should seriously think in the Philippines be desired by the government, particularly of developing a program specifically on the Department of Health, with regard to the reduction of alcohol-related harm. The Last year, two important pieces of evidence-based data and implementation program may take the form of the National legislation on alcohol control were enforced – of policies and program on the reduction Tobacco Control Program in which multi- Republic Act 10351 (An Act Restructuring the of alcohol-related harm vis-à-vis youth sector collaboration is deemed necessary to Excise Tax on Alcohol and Tobacco) otherwise drinking. The DOH is concerned about the implement various strategies that include known as the Sin Tax Reform and Republic Act issue yet not many focused efforts take development and implementation of No. 10586 (An Act Penalizing Persons Driving place. Reduction of alcohol-related harm policies, settings approach advocacy, and Under the Influence of Alcohol, Dangerous in the DOH remains to be fragmented and education. Drugs and Other Similar Substances) also only a small part or just mere alcohol control Following the WHO Global known as the “Anti-Drunk and Drugged message are incorporated in various health Strategy to Reduce Harmful Use of Alcohol Driving Act of 2013”. The Sin Tax is already programs/campaigns such as the prevention and the Regional Strategy to Reduce Alcohol-Related Harm, the 10 areas for policy measures and interventions must be addressed: 1) leadership, awareness and commitment; 2) health services' response; 3) Community action; 4) drunk-driving policies and countermeasures; 5) availability of alcohol; 6) marketing of alcoholic beverages; 7) pricing policies; 8) reducing the negative consequences of drinking and alcohol intoxication; 9) reducing the public health impact of illicit alcohol and informally produced alcohol; and 10) monitoring and surveillance. With the high proportion of young people and increased alcohol consumption in the Philippines, more specific action is urgently needed to address the harmful use of alcohol by young people. The DOH can look at the WHO strategy through a youth lens and even draft a country-specific youth Art by Antonio Totto, Jr. strategy and effective interventions.
18 HEALTHbeat I January - February 2014 tobacco CONTROL
Lung Center of the Philippines is one of the DOH hospitals that offer smoking cessation services. (Photo courtesy of Riza San Juan) Smoking Cessation Clinics Health Secretary Enrique T. Ona, tobacco-related deaths over the next 30-50 times.” Quitting is not that easy because in a press statement on January 21, 2014, years unless adult smokers are encouraged tobacco dependence is a cluster of behavioral, urged smokers who want to quit visit to quit. Due to the addictiveness of tobacco cognitive and physiological phenomena. smoking cessation clinics all over the country products, tobacco users will need support in Very few tobacco users can successfully quit and that there are enough health workers quitting. However, only a small percentage the habit in their first attempt. However, the and medical professionals to help. He said, of cigarette smokers (1-3%) achieve lasting evidence is strong that quitting can be done. “The time to quit is now.” abstinence, which is at least 12 months of Nicotine – one of the three main The Philippine Global Adult abstinence from smoking, using will power components of cigarettes – the other two Tobacco Survey conducted in 2009 revealed alone. being tar and carbon monoxide – is the that 17.3 million (28.3%) Filipinos aged 15 An array of reasons why smokers most addictive. It is absorbed into the blood years and above currently smoke tobacco. want to kick their bad habit, including: and affects the brain within 10 seconds. It Of this total, 14.6 million (47.7%) are men health problems caused or exacerbated by causes smokers to feel good because of the while and 2.8 million (9%) are women. smoking; children or loved one being affected chemicals in the brain that nicotine releases. About 80% of these men and women by smoking; expectations of benefits for self It also causes a surge of heart rate, blood smoke daily averaging 11.3 and 7 sticks of and others; personal appearance and smell; pressure, and adrenaline which also feels cigarettes per day respectively. However, increasing price of cigarettes; and the desire good. more than half (60.6%) of them want to to achieve self-control. Others want to quit But nicotine also leaves the brain quit. This translates to around 10 million for increased energy or physical endurance, as fast as it enters, thus craving for another Filipinos needing help to quit smoking. and because of the support for quitting they cigarette sets in. For heavy smokers and According to the World Health get from family and friends. those who started smoking at a very young Organization's Policy Recommendations for The world renowned American age, quitting causes nicotine withdrawal Smoking Cessation and Treatment of Tobacco author and humorist Mark Twain quipped, syndrome that leads to irritability, frustration Dependence, it will not be possible to reduce “Quitting is easy, I’ve done it a thousand Please turn to page 21...
January - February 2014 I HEALTHbeat 19 20 HEALTHbeat I January - February 2014 ...Continued from page 19 cessation services are necessary indicators If smokers quit at any age, the or anger, anxiety, difficulty concentrating, to be considered 100% tobacco-free LGU, body repairs itself quite quickly. Nicotine decreased heart rate, sleep disturbance, government health facility or office. leaves the body in just two hours, and the and even increased appetite or weight gain. In Metro Manila, smoking deadly chemical, carbon monoxide, leaves These become barriers to stop smoking. cessation clinics are located in the Dr. Jose the blood stream after only 12 hours. Tobacco dependence should be Rodriguez Memorial Hospital in Kalookan Nicotine by-products are gone within two viewed as a chronic disease that requires City, Amang Rodriguez Memorial Hospital in days. Within two months, the blood flow multiple interventions and sometimes Marikina City, Rizal Medical Center in Pasig to the arms and legs improves, and the many quit attempts are needed. Practical City, San Lorenzo Ruiz Women’s Hospital lungs begin to repair themselves in about counselling (problem solving and skills in Malabon City, the Philippine General three months. The sense of taste and smell training) and social support are important Hospital in Manila, the Lung Center of the improves, the skin will lose the 'grey' look parts of treatment. Brief advice rather than Philippines, Philippine Heart Center, National that smokers get, and the body will be free constant reminders is effective. Thus, it is Children’s Hospital, St. Lukes Medical Center, of that stale tobacco smell. And the chance also very important for health workers, in and Quirino Memorial Medical Center, all in of getting heart disease and cancer begins to taking a medical history of the patient, to ask Quezon City. fall. if he/she is smoking or is constantly exposed to secondhand smoke and then offer some brief advice and guidance. Also included in the wide range of Quit COLD TURKEY Tips smoking cessation techniques is the use of Quitting abruptly or going "cold turkey" may be unpleasant at first but it is more effective appropriate nicotine replacement therapy than tapering down the number of cigarette being smoked. like patches, gums, lozenges, inhalers and sprays as well as bupropion and varenicline, Once you have decided you want to quit, encourage you to quit. the effective drugs of choice for treatment. plan before you stop: Meanwhile, acupuncture, hypnotism, • Throw away all cigarettes, lighters, Remember each craving only lasts a few electronic cigarette, and other other and ashtrays in your home and car. minutes: methods for smoking cessation have NOT • If your partner smokes, suggest • Use the 4Ds – delay smoking; been scientifically proven to be effective. that he or she stops, too, or only deep breathing; drink water; All these techniques aimed at smokes outside the house. and do something else. encouraging and helping smokers to stop Children in the house suffer • If you have a cigarette, it's not using tobacco and avoid subsequent relapse. if anyone smokes in your home. the end of your quit attempt. Ona stressed, “Evidence has shown that • Plan how to handle the places and A slip-up is a setback, not a cessation is the only intervention with the events that you know make you defeat. Continue quitting. potential to reduce tobacco-related deaths want to smoke. If possible, avoid and should therefore be a part of an overall them in the first few weeks. Treat yourself with money you have saved. comprehensive tobacco control policy of any • Talk to your family and friends Your efforts deserve to be rewarded! country.” about how they can help and The DOH has already established smoking cessation clinics and trained health staff in all of its regional offices. It also continues to advocate for other health www.beat-tobacco.ph facilities and local government units (LGUs) to make available smoking cessation services. In the DOH Red Orchid Awards, the provision and utilization of smoking
January - February 2014 I HEALTHbeat 21 tobacco CONTROL
Graphic Health Warnings Now
Death For Sale Warning the public of the hazards by pro-tobacco congressmen. In 2010, sans of tobacco use is part of the World Health the law, the Department of Health issued "How Do You Sell Death..." – a Organization Framework Convention on Administrative Order (AO) 2010-0013 brochure developed by the American Cancer Tobacco Control (WHO FCTC), the first requiring graphic health information and Society, Framework Convention Alliance global treaty devoted to public health prohibiting misleading descriptors such as and the Campaign for Tobacco-Free Kids that focuses on supply and demand, and “light,” “mild,” or “ultra” on cigarette packs. – describes cigarette packages to be an harm reduction strategies to improve the The DOH issued this Order within its mandate important part of the tobacco industry's health of the population by eliminating or under the Consumer Act, the Administrative marketing strategy since they are literally reducing smoking and secondhand smoke Code, and Article 11 of the WHO FCTC and the "face" of the product they are promoting. exposure. The Philippines has ratified the its implementing guidelines. As expected, Unlike many other products, cigarette FCTC and it entered info force in the country tobacco companies opposed the AO and filed packages are viewed constantly, each time in September 2005. six lawsuits to stop its implementation. The a smoker lights up. Package design is used Article 11 of the WHO FCTC zeroes DOH is still awaiting the Supreme Court to to reinforce brand imagery, to minimize in the international guidelines for tobacco issue its final decision to these lawsuits. This perceptions of risk, and to contribute to the packaging and labelling. It covers three year marks the sixth year since the country smoker's identity. primary areas, namely: 1) government- lapsed on its deadline to implement GHWs. For the same reasons, tobacco mandated health warnings; 2) labelling of control efforts have leaned toward the tobacco constituents and emissions, and; 3) Show and Tell use of picture-based health warnings the removal of misleading information from a.k.a. graphic health warinings (GHWs) on the package. A picture paints a thousand words tobacco packaging which have the potential As an obligation to the WHO and GHWs hit home fast and hard. The for extensive reach for tobacco users and FCTC, the Philippines should have already reach of these health warnings on tobacco constitute one of the strongest first lines of implemented GHWs on cigarette packs packaging cannot be underestimated. defense in tackling the global epidemic of by 2008. However, the GHW bill filed in A recent study conducted by tobacco use. Congress that year was vehemently opposed the Harvard School of Public Health and
22 HEALTHbeat I January - February 2014 Legacy, a public health foundation in the US, (SBN) 27 authored by Senator Pia Cayetano smokers to quit and discourage non-smokers provides evidence that hard-hitting pictorial and SBN 499 authored by Senate President from ever starting to smoke. cigarette warnings visually depicting health Franklin Drilon on January 22, 2014. The DOH position paper further effects of smoking play a life-saving role in Cayetano said in a press statement noted that studies show that GHWs on emphasizing the dangers of smoking and before the hearing, "This will be 'round tobacco products are effective ways of encouraging smokers to quit. The research three' for the GHW Bill which failed to pass informing smokers on the hazards of examined the reactions to cigarette warning in the 14th and 15th Congress due to strong smoking. Evaluations made on many labels from 3,300 smokers and found that resistance from the tobacco industry. I hope countries that require GHW on tobacco GHWs are more effective than text-only that this time around, we will have more products conclude that they are effective warnings. Smokers included in the study colleagues who are ready to support the in discouraging smoking and increasing indicated that GHWs are more impactful, GHW Bill in the interest of public health." public awareness on the effects of smoking. credible and have greater effect on their Cayetano’s bill requires cigarette However, the size and position of GHWs intentions to quit. and tobacco product packages to bear full- in cigarette packs are critical to their A Social Weather Station (SWS) color graphic health warnings occupying effectiveness. survey done in December 2012 reflects a at least 60 percent of the upper front and In a report posted in Inquirer. strong public support for the passage of 60 percent of the upper back panels of the net on January 24, Cayetano said that the the GHW law in the Philippines that would packaging. The warning should consist of tobacco companies have “in principle” effectively deter the public, especially the a picture showing the health dangers of indicated their support for the measure but youth, from smoking. The survey said that tobacco use or exposure to second-hand also proposed changes to the measure. The eight out of 10 (81%) Filipinos are in favor smoke, and a textual warning related to the Senator was quoted as saying, “The concerns of Congress to enact a GHW law, and 77% of picture. Both components should comply they raised dealt with details, such as the Filipinos agree that this move will help them with guidelines issued by the DOH. size of the GHW on the cigarette packs, decrease or stop smoking. Meanwhile, Drilon’s bill seeks to which is understandable. I feel we could Several countries in the Association prohibit cigarette packages from bearing work this out with the other side, the health of Southeast Asian Nations (ASEAN) have descriptors that would directly or indirectly advocates who want a bigger graphic health already implemented the placement of suggest that a particular tobacco product is warning. I hope that we can resolve this and GHWs on cigarette packs, namely: Thailand, less harmful than any other tobacco product have a law.” Brunei, Singapore, Vietnam and Malaysia. or brand. Samples of such descriptors The size and the placement of the Even Indonesia, the only ASEAN country that include, but are not limited to “low-tar,” GHW on tobacco product packages will be is not a signatory to the WHO FCTC, is set to “light” and “mild.” the center of deliberations in Congress if the place GHWs by July 2014. The Philippines The DOH, for its part, supports the legislators would finally agree that a law be is lagging behind with only text warnings passage of the bills with utmost priority. passed. Senator Miriam Defensor Santiago placed at the bottom of the front panel of The position paper dated January 20, 2014 already filed her own version of the bill on cigarette packs. signed by Health Secretary Enrique T. Ona January 15 requiring the textual health reiterated that the Philippines being a party warning printed bottom portion of the front GHW Battle Begins in Congress to the FCTC is obliged to implement its panel occupying 35% while the GHW printed provisions. The DOH also noted that studies at the bottom portion of the back panel After the Sin Tax law was enacted show many smokers have no knowledge occupying 45%. by the 15th Congress in December 2012, a about the ill effects of smoking that cause Meanwhile at the House of new battle begins in the 16th Congress to diseases and premature deaths. Others know Representatives, at least eight bills have been pass a law on GHWs on tobacco product a little beyond a vague notion that “Smoking filed in the Committee on Health requiring packages. is dangerous to your health." Thus, there GHWs on tobacco products, as of January 31. The Senate Committee on Health is an urgent need to have specific, strongly The principal authors of these bills include and Demography took the lead by conducting worded and larger label information on Congressman Marcelino R. Teodoro, Neil C. its initial public hearing on Senate Bill No. tobacco product packages to encourage Tupaz, Jr, Joseph Gilbert F. Violago, Eric D.
January - February 2014 I HEALTHbeat 23 Singson, Leah S. Paquiz, Ibarra M. Gutierrez with 17.3 million adults smoking. More that one’s attention is easily grabbed. While III and Walden F. Bello, Jerry P. Trenas, and than 87,000 Filipinos die every year because the industry is barred by law to advertise Edcel “Grex” B. Lagman. In the majority of of smoking – that’s more than the number their products, these packages serve as the bills, the size of the GHW ranged from of those who succumb to heart attack and the cheapest way to communicate to their 50% to 85% of the front and back panels, stroke. This is clear and present danger that potential customers." while the bill filed by Singson requires 30% must be addressed at the soonest.” A study released by the Institute text warning at the bottom of the front panel According to the Southeast Asia for Global Tobacco Control at Johns Hopkins and the 30% GHW at the bottom of the back Tobacco Control Alliance (SEATCA), the Bloomberg School of Public Health in panel. As of this writing, no public hearing Philippines is among the top three countries October last year, revealed the immense has been set yet. with the most number of smoking women in effects of tobacco marketing at reaching the region. It is estimated that nine percent kids in low and middle-income countries. Cancer Survivors Demand GHWs of Filipino women are smokers, more than The survey showed more than two-thirds of their counterparts in Indonesia, the country children aged 5 to 6 were able to distinguish The New Vois Association of the that holds the most number of tobacco at least one cigarette brand through its logo Philippines (NVAP), a civil society group consumers in the region. Only 4.5 percent of in Brazil, China, India, Nigeria, Pakistan, and composed mainly of throat cancer survivors, Indonesian women are smokers. Meanwhile, Russia. Some of the children surveyed do not continues to demand for the passage of an estimated 10.5 percent of Filipino children live with smokers and are just exposed to the GHW law. Emer Rojas, NVAP’s president aged 13-15 years are also smoking. these logos through displays in retail stores. and a global cancer ambassador, said, "Ten Rojas said, “The tobacco industry is “Implementing a law that will per cent of the world’s 1.3 billion smokers out to target a new generation of smokers. mandate the industry to place GHWs is not can be found in Southeast Asia where the All around shelves in various groceries and just about passing a legislation, it’s about Philippines belong. We are the second convenient stores you see cigarette packs addressing a public health concern. GHWs largest smoking population in this region designed like chocolate bars and lipstick will tell women, children and the poor the real effects of smoking and they can make an informed choice if they will still go for it,” said Rojas.
Yosi Kadiri
While waiting for a law to be passed, the DOH continues to expose the ill- effects of smoking through health promotion and advocacy campaigns targeting the youth and young adults in schools and workplaces via “Smoker’s Body” (a graphic representation of what smoking does to the different parts of the body) and “Yosi Kadiri” (a mascot depicting the ugly effects of smoking to one’s personality). The DOH messages remain clear: ‘Quit Smoking’ for those who currently smoke New Vois Association of the Philippines (NVAP) – a civil society group composed mainly of throat cancer and ‘Be Smart, Don’t Start,’ for children and survivors – continues to demand for the passage of the GHW law. The photo shows the press conference adolescents who are the main targets of before the Right to Health Walk of cancer survivors and persons with disabilities on January 17, 2014. Among the speakers are NVAP President Emer Rojas (right) and Health Assistant Secretary Enrique A. the tobacco industry in its advertising and Tayag (second from left). marketing campaigns.
24 HEALTHbeat I January - February 2014 RISK communication
TOP: Lakbay Buhay Kalusugan: Kalusugan Pangkahalatan on Wheels - a health promotion bus roving in Yolanda-affected areas becomes the symbol of the Department of Health that health is on the way. ABOVE: (Left) The National Center for Health Promotion, Bicol Medical Center, DOH Regional Office in Eastern Visayas and local government health staff deliver basic medical consultation and risk communication. (Right) The team is fortunate enough to meet and talk with Tacloban City Mayor Alfred S. Romualdez who is doing his rounds of evacuation centers. HEALTH IS ON THE WAY by NEIL BRYAN S. HIPOLITO, RN and LIZELLE CHRISTINE F. JUSAYAN National Center for Health Promotion Much has been said about the 8, 2013. The national and local governments Eastern Visayas where the 15 feet storm devastation brought about by Super were overwhelmed in their response and surge almost flattened some areas. Typhoon Yolanda that affected several areas relief efforts, and now it will take years for Right after the disaster, the in eight regions of the country on November recovery and rehabilitation, particularly in Please turn to page 28...
January - February 2014 I HEALTHbeat 25 Dagat na, dagat na! "Noong gabi pa dagat na! Sumigaw ako sa sa lang sinabihan ko na yung asawa ko, DAGAT NA! DAGAT mga anak ko na mag-ayos ng NA! Yung mga niyog inaanod mga gamit nila. Mga 4 o'clock na ng tubig. Yung Nanay ng umaga ginising na kami ng asawa ko kinarga niya. ng asawa ko at ang sabi niya Pumunta kami sa bundok ay huwag na kaming matulog para di kami abutin ng tubig dahil lumalakas na yung dagat. hangin. Maraming salamat Tapos nung malakas sa lahat lahat ng tulong ninyo. na ang hangin yung asawa ko Sa mga nanunungkulan sa nakatingin sa labas at kami ng gobyerno, sana matulungan mga anak ko ay nasa bintana. kami kasi hirap na hirap na Dasal namin, ‘Lord sana yung talaga mga tao dito. Dapat hangin umokay na.’ Iyong alamin nila kung sinu-sino ba mga puno nagbabagsakan na, talaga ang dapat matulungan. ‘yung bubong ng mga katabi Baka mapunta lang kung naming bahay ay lumilipad kanino ang ibibigay nila.” na. Noong medyo humupa na ang hangin, pagtingin ko sa - EVANGELINE ABALOS likod ng bahay namin, naku, Brgy. Opong, Tolosa, Leyte
Photos in this article by Joerem Ceria, Clarence Damasco and Neil Bryan Hipolito
26 HEALTHbeat I January - February 2014 Kailangan magtiis... "Maraming beses lang makagawa kami ng na rin kaming nadadalaw bahay. Mabuti na lang at ng DOH at matutuwa at nakaligtas kami ng mga nagpapasalamat kami na anak ko. Tinulungan ako ng pinupuntahan kami dito. mga kapitbahay na kargahin Nakakaraos naman kami ang mga anak ko sa bubong. sa aming pang-araw- Pero ‘yung kapatid ko at saka araw, kaya lang nga pila mga anak niya nawala lahat. kami nang pila. Kailangan Nawala na silang lahat at magtiis kasi marami kaming hindi pa namin natatagpuan nangangailangan ng tulong. ang katawan nila.” Sa ngayon, namu- January - February 2014 I HEALTHbeat 27 mulot kami ng mga kahoy - LIZELLE PABI na inanod nung baha para San Jose, Leyte ...Continued from page 25 Department of Health did not only send the needed medicines and medical supplies but also waves of medical teams to ensure that people in affected communities have access to emergency, basic and even comprehensive services. And as post-Yolanda efforts entered the early recovery period, the DOH shifted its focus to public health as threats of epidemics loom in vulnerable communities that do not have access to safe water and which suffer from poor or inadequate sanitation or vector control. One of the interventions employed by the DOH is risk communication in the attempt to manage some of the stresses after the disaster by ensuring efficient and Inisip ko agad na tutulong ako... accessible quality health services, preventing "Nasa bahay ako noong tutulong ako. This is the time na kailangan and reducing risks to individual health and mangyari ‘yung bagyo. Around 6:00 am ang serbisyo ko kahit pa nga napaka-risky the overall environment, and promoting nang magising ako, humahangin-hangin ng pupuntahan namin, walang monetary healthier lifestyles. na. Nanonood pa nga kami sa labas kung benefits ang ilalaan kong serbisyo, o Health promotion / information ano ang nangyayari. After three hours, kaya ay kung may second chance pa ako officers of the DOH National Center for malakas na talaga ‘yung bagyo. Biglang para manatili sa RN heals program. ‘Yung Health Promotion (NCHP) teamed up with taas ang tubig, abot tuhod. Tapos ‘yung co-nurses ko sa RN heals, ganoon din at doctors, nurses and other paramedical tubig maitim na at may kasama pang kayang-kaya pa din naman mag-serbisyo. staff of various DOH central and regional debris. Doon ako nasugatan. Inakyat ko na Ang naging problema lang ay wala silang offices and hospitals to offer “Oplan: ang mga magulang ko sa second floor ng matuluyan kasi sira ang lahat ng bahay. Handog Kalusugan,” in coordination with bahay namin. ‘Nung nagpo-provide kami ng the affected local government units and Noong unang linggo matapos serbisyo sa ilang lugar, na-appreciate communities. As the medical team provided ang bagyo, medyo okay ang delivery ng naman talaga ng tao. Nagpapasalamat consultation and immunization services, the mga health services kasi nga maraming ang karamihan sa aming pagdating para health promotion staff conducted health supplies at pumupuntang health workers magbigay ng tetanus toxoid vaccine at education on the potential risks of outbreaks from other regions. Nagkaka-problema medical consultation. Ang akala nila sa and epidemics of diarrhea, measles, dengue, lang kung saan sila ide-deploy at kung sino City Health Office pa sila pupunta. leptospirosis and other diseases that ang kokontakin. Tapos, nagkakawalaan Para sa DOH, I guess, i-continue commonly occur in disaster areas, temporary noon ang mga nurses namin kasi ‘yung ang support at ‘yung spirit of providing shelters and evacuation centers. They also iba umalis agad. Nagkaroon tuloy ng selfless service to the people, kahit distributed health information materials to limitation ang health personnel dahil nagkakaroon ng kakulangan sa supplies at the public as well as media organizations in hindi naging sapat ang kanilang bilang human resources. At least nakikita ng mga the area. para maibigay lahat ng pangangailangan tao na aktibo tayo sa pagtulong sa kanila.” At the center of the activities is the ng tao. Lakbay Buhay Kalusugan (LBK) - Kalusugan ‘Nung nalaman kong kulang - DAWN BELTRAN Pangkalahatan on Wheels, a bus especially sa health personnel, inisip ko agad na RNheals Nurse converted into a mobile consultation and examination clinic. LBK was originally
28 HEALTHbeat I January - February 2014 intended as a health promotion caravan to assist the DOH Central Office team on In extreme disasters and health to celebrate good health through a fiesta- its assessment of the health situation and emergencies including Yolanda, people like setting and spread key messages on medical mission while in the second trip often see the grim pictures of body bags with health-seeking behaviors and practices on December 1-5, 2013, health promotion the screaming DOH logo in news reports. on safe motherhood, child health and and risk communication activities were These pictures do not exactly convey health. nutrition, family planning and responsible incorporated by NCHP to the medical mission With the LBK bus roving in Yolanda-affected parenthood, and prevention of teenage provided by the Bicol Medical Center. In the areas, it becames the symbol of the DOH that pregnancy through exhibits, fun and games. latter trip, the team was able to visit two health is on the way. However, LBK has now been proven effective evacuation centers in San Jose Elementary Rosemarie Aguirre, NCHP division in health emergency response operations in School and a nearby Iglesia ni Kristo church chief and head of the risk communication Yolanda-affected areas. as well as Leyte Progressive High School, and team, said, "The LBK bus was utilized Without going too far off the LBK’s two barangays – Brgy. Maribe in Tanauan for transporting the medical and health original concept, the risk communication and Brgy.Opong in Tolosa. promotion team to different places. It also activities also included lectures, exhibits, and In one of these sites, the team was provided comfort to patients that entered even demonstration of proper handwashing fortunate enough to meet and talk with the bus for consultation. On the other hand, technique through dance using Psy’s hit Tacloban City Mayor Alfred S. Romualdez the risk communication activities done song “Gentleman.” who was doing his rounds of evacuation outside the bus encouraged people to think The LBK has already made two trips centers. He recognized the efforts of the and practice healthy habits despite their to Leyte in the first month after the disaster. DOH and was very grateful for the assistance seemingly hopeless condition." The first trip on November 13-20, 2013 was given by the department. - o O o -
January - February 2014 I HEALTHbeat 29 HEALTH awards
Health Assistant Secretary Enrique A. Tayag and DOH Health Promotion Director Ivanhoe C. Escartin (back row, fourth and third from left) recognize the winners of the "Parangal sa mga Kuwentong Kalusugan Pangkalahatan”. Photos of winners courtesy of Kara M. Santos of Probe Media Foundation, Inc. DOH Honors Top 10 Stories on KALUSUGAN PANGKALAHATAN Ten stories on the importance Kuwentong Kalusugan Pangkalahatan” of the country's public health targets in the of maternal and child health, nutrition, (Recognizing Stories on Universal Health Millennium Development Goals (MDGs). breastfeeding, access to health facilities, and Care), the health awards commended Dr Enrique "Eric" Tayag, DOH social health insurance were recognized by media practitioners whose works highlight assistant secretary and spokesperson for the Department of Health for their ability good stories under the theme of Kalusugan public health, said, “By telling their stories, to share ordinary folk’s strides in making a Pangkalahatan – the health reform agenda of their struggles and little successes in life, health-conscious community and healthy of the Aquino administration, which our friends in the media will be powerful family. (See complete list of the winning covers a range of issues like financial risk instruments in getting the message across. stories in the next pages.) protection through social health insurance, Needless to say, we should have healthy Dubbed as “Parangal sa mga access to health facilities and attainment Please turn to page 32...
30 HEALTHbeat I January - February 2014 Top 10 Stories on Kalusugan Pangkalahatan TELEVISION
SILANG MGA WALA SA MAPA NUTRITION Reel Time, Investigative Documentaries GMA News TV GMA News TV The documentary tells the story of Filipino medical volunteers, Two out of 10 children are underweight while 3 out of every led by Dr. Roel Cagape, who give their selfless services and compassion to 10 are overweight. In Metro Manila, 7% of the population is obese. the less fortunate members of the B'laan tribe from Saranggani Province. Many people do not have the proper livelihood to buy nutritious food Dr. Cagape introduced Ambulansyang Kabayo to transport sick patients for their families, while others do not have enough knowledge on a from remote villages during emergency situations. He also created proper diet. One of the targets of the MDGs is to decrease the incidence of medical programs e-text kay Doc and Botika sa Barangay, catering to underweight Filipino children, but current data show the country has far people seeking medical advice at any time of the day. to go to achieve this goal before the 2015 deadline. RADIO BIDA SPECIALS: CHOLERA OUTBREAK Notre Dame Broadcasting Corporation (Kidapawan, North Cotabato) by Malu Cadelina Manar The 30-minute documentary talks on the cholera outbreak in a remote village in Parang, Maguindanao, and introduces the community-led total sanitation activities, particularly the proper disposal of human waste, as solutions to stop the problem.
BIDA SPECIALS: BANGIS NG DENGUE Notre Dame Broadcasting Corporation (Kidapawan, North Cotabato) by Malu Cadelina Manar The documentary focuses on how virulent the dengue virus has become. Since January 2013, Kidapawan City recorded the highest number of dengue cases in North Cotabato, and had the highest mortality rate. Chikungunya, another disease caused by the dengue mosquitoes, is also discussed here as well as ways on how people could prevent the spread of these diseases.
January - February 2014 I HEALTHbeat 31 Top 10 Stories on Kalusugan Pangkalahatan PRINT
PHILHEALTH IMPLEMENTS ‘NO BALANCE BILLING' SCHEME BREAST WARS: LIFE SAVING WITH BREASTFEEDING Philippine Star Sun Star Cebu by Sheila V. Crisostomo by Ma. Theresa Q. Tabada The article gives a newsworthy and practical approach to and Cherry Ann T. Lim explaining the Philippine Health Insurance Corporation's (PhilHealth's) case payment scheme for specific medical cases and surgical procedures The two-part special feature looks at the road that Cebu City and the "no balance billing" scheme to equalize the reimbursements of took in becoming a breastfeeding champion and the challenges the city private and government hospitals and to maximize the benefit packages had to overcome to sustain the breastfeeding practice that will definitely of its members. save more lives. ONLINE
MORE THAN HALF A MILLION PINOY KIDS AT FABELLA HOSPITAL, SUFFER FROM SEVERE MOMS ARE HUMAN MALNUTRITION INCUBATORS GMA News Online GMA News Online by Claire Delfin by Denise M. Chiu The story details how malnutrition makes Filipino children, the A look at the ingenious techniques the Dr. Jose Fabella third poorest and most disadvantaged sector in the Philippines, next to Memorial Hospital has developed to cope with the lack of resources and fishermen and farmers, and highlights efforts in saving these children. an increasing number of teenage mothers. The story provides a unique The story, in particular, was meant to urge voters to use their voting look into why the reproductive health law is necessary in ensuring power to help end children’s miseries. maternal and infant health in the Philippines.
32 HEALTHbeat I January - February 2014 Top 10 Stories on Kalusugan Pangkalahatan SPECIAL CITATION: BLOG BREAKING THE CODE: SAVING THE BABIES!
A commentary blog post about the attempt of multinational commercial milk companies to amend Executive Order 51 or the Milk Code of the Philippines, a law that ensures safe and adequate nutrition for infants through the promotion of breastfeeding and the regulation of promotion, distribution, selling, advertising, product public relations, and information services of artificial milk formulas and other covered products. The blog post received good responses from breastfeeding advocates in Twitter, and it was picked up and republished by “unBlogged,” the official blog section of PhilStar.com, which features emerging and seasoned bloggers.
HPV VACCINATION: WHY PARENTS HAVE SECOND THOUGHTS – AND WHY THEY SHOULDN’T
Parents in the Philippines are having second thoughts about getting their children vaccinated against the human papilloma virus (HPV) despite its proven cost-effectiveness in preventing cervical cancer. This layman-friendly article on why parents shouldn’t hesitate, emphasized the value of prevention over cure, and cited evidence to support the points. Making health decisions to prevent disease (in contrast to treating them) can be difficult: Most people give low salience to prevention, especially in our country. Sharing this article to Filipinos just might urge everyone to take a more active stand against cervical cancer and other health issues. The article was also published in the social health community blog, Talk Health Partnership.
...Continued from page 30 published, broadcasted or posted online rated for their coverage of the overall theme, citizens to be able to build empowered between January 1, 2012 and June 30, content, and overall technical quality. communities.” 2013. The entries were written in English or The preliminary judging panel A total of 114 entries produced by Filipino, but those in the local language were was composed of: Anthony Roda of the DOH 43 media practitioners vied for the health accepted if they had English translation. A National Center for Health Promotion (also media awards. Two entries each from four media practitioner was allowed to submit chief editor of HEALTHbeat); Rom Dongeto media categories – print, radio, television, up to five entries and could win twice. The of the Philippine Legislator’s Committee and online were selected as winners, deadline was set on May 31, 2013 but was on Population and Development; Ariel including two special citations awarded extended until August 31, 2013. Sebellino, executive director of the Philippine to bloggers who also happen to be health Out of the 114 entries submitted, Press Institute; Johanna Son of Inter Press practitioners. Each winning story received only 94 stories were eligible as complying Service Asia Pacific; print journalist Diana P20,000 cash and a trophy. to the set criteria. The stories underwent Mendoza; and broadcast journalist Booma two layers of review including a preliminary Cruz. Joining and Judging judging, where 22 finalists were shortlisted The final panel of judges and a final judging where a panel identified was composed of both health and All submitted entries were 10 winning stories. The media entries were media representatives, namely: DOH
January - February 2014 I HEALTHbeat 33 Components of Lakbay Buhay Kalusugan: Kalusugan Pangkalahatan on Wheels
Undersecretary Janette Garin; Dr Israel Lakbay Buhay Kalusugan (LBK): Kalusugan in areas it visited. In its recent trips, however, Francis Pargas of PhilHealth; Cecilia “Che Pangkalahatan on Wheels - a comprehensive the LBK has also been proven effective in Che” Lazaro of Probe Media Foundation, health promotion caravan that brings bringing health information and services in Inc.’ and Redmond Batario of the Center for information, education and entertainment areas devastated by Typhoon Yolanda. Community Journalism and Development. to all members of the family in remote LBK is a model for public-private ASec Tayag and Dr Ivanhoe C. communities. LBK features a customized partnerships in health promotion and Escartin, director of DOH National Center bus equipped with consultation and clinic service delivery. The media has always been for Health Promotion, led the awarding areas where pregnant women, mothers an important partner in the implementation ceremonies held at the Bayleaf Hotel in and children are provided with basic health and promotion of LBK that the DOH saw it Intramuros, Manila on November 29, 2013. services as well as practical information on fit to also recognize the great support it has safe motherhood, childbirth, nutrition, birth been receiving from media practitioners. LBK Gives Back spacing and healthy lifestyle. Probe Media Foundation, Inc. is a media Director Escartin said that the LBK organization that has been helping the DOH Parangal sa mga Kuwentong has been conceptualized to provide health in implementing this LBK in the last three Kalusugan Pangkalahatan is an offshoot of promotion activities in a fiesta atmosphere years.
34 HEALTHbeat I January - February 2014 MEDIA awards "The Doctor is In" Gets an Anak TV Seal
"THE DOCTOR IS IN," a 30-minute seal is bestowed by various stakeholders Jury’s nod in the final round are then health news and feature stories produced by (including parents, educators, business and endorsed to the board of the SEAFCTV the Department of Health-National Center media people, government, media, non- (composed of network presidents and for Health Promotion and aired on People's government organizations, the religious general managers), which formally declares Television (PTV-4) received an ANAK TV sector an youth) on TV programs airing the chosen entries as winners of the ANAK SEAL in an award ceremony held at the Soka on Philippine television, whether locally- TV SEAL. The seal can now be displayed Gakkai Building in Quezon City on December produced or not, which they think are child- during the airing of the program as a guide 12, 2013. sensitive. The criteria used are as diverse to parents and educators that the program "The Doctor is In" is hosted by as the disciplines represented in the multi- has been screened not just by the industry the country's foremost epidemiologist and sectoral jury. or a government institution but by the a Department of Health's spokesperson, A Primary Level Jury composed thick layer of stakeholders, not only in Metro Assistant Secretary Enrique "Eric" Tayag and of over 3,000 jurors screens the entries Manila but nationwide. co-host, Dr. Darah Chavez. It tackles current employing flexible guidelines. These It is hoped that teachers and health issues affecting the country, health judging sessions are held all over the country parents will rally behind the chosen tips and ideal practices of individuals and from February to October. The Secondary programs, encouraging children to view communities to contribute to a healthier Level Jury, where the qualified entrants are them, increasing popular viewership, which Philippines. elevated to, scrutinizes the programs from will hopefully translate to better revenues The ANAK TV SEAL is a national various vantage points such as the moral for such responsibly-made programs. award created by the Southeast Asian slant, artistic merit, educational content, Watch out for new season episodes Foundation for Children and Television cultural relevance and others. this 2014! (SEAFCTV). According to its website, the Entries that receive the Secondary - o O o -
LEFT PHOTO: Health Assistant Secretary Enrique "Eric" Tayag and Dr. Darah Chavez host "The Doctor is In" aired on People's Television (PTV-4). RIGHT PHOTO: Director Ivanhoe C. Escartin and Division Chief Rosemarie G. Aguirre (on centerstage) of the DOH National Center for Health Promotion receive the Anak TV Seal for the show.
January - February 2014 I HEALTHbeat 35 stress RELIEF KASALANAN KITA 7 Kasalanang Nakamamatay Tunay na Kagandahan Bigay ni Mister
1. SELOS TERE: Ang tunay na kagandahan ay GRACE: Ang ganda ng kwintas mo! Nakakawala ng tiwala sasarili. hindi nakikita sa pisikal na DELIA: Galing sa Mister ko. He was 2. INGGIT anyo ng isang tao kundi nasa forced to buy it for me kasi Nakakawala ng pera sa bulsa. puso. nahuli ko siyang hinahalikan 3. GALIT SHEILA: 'Yan ang paniwala ng mga ang maid namin. Nakakawala ng ganda ng mukha. pangIt, Mare! GRACE: Terrible! Pinalayas mo na ba 4. KASAKIMAN TERE: Oo nga. Kaya tayo quiet lang! 'yang maid mo? Nakakawala ng kaibigan. DELIA: Hindi pa. Gusto ko pa ng 5. KATAKAWAN Just Friendly matching earrings, eh. Balak Nakakawala ng ganda sa katawan. ko pa ngang magdagdag 6. KAYABANGAN MADEL: Malandi ka! ng maid. Nakakawala ng hangin sa kapaligiran. GED: I’m not malandi. I’m just 7. KAMUNDUHAN friendly with a twist. Adik Nakakawala ng enerhiya sa katawan. Limot Ko Na RAUL: 'Pre, ano ba ang mas Kakaibang Trip nakaka-adik, drugs or sex? GILBERT: Pare, may nakalimutan ako... ED: Ayon sa survey, 99 sa 100 AURORA: Bading ka ba? GLEN: Ano 'yun? na babae ang sumagot ng JERRY: Hindi ah. GILBERT: Bobo ka ba? Nakalimutan ko "It depends on the pusher!" AURORA: Halikan mo nga ako. nga, eh! JERRY: Ayoko. Aanhin Pa? AURORA: Halikan mo ako sabi eh! Wala Lang JERRY: Ayoko nga... Isang lalaking sawi ang nagwari... AURORA: Bading ka nga. CALOY: Nakakita ka na ba ng wala? Aanhin pa ang gabi, kung wala ka JERRY: Hindi nga. (Biglang sigaw sa ROMMEL: Niloloko mo ba ako? Wala nga, namang katabi? ka-tropa.) Tol! Ano ba itong lola paano ko makikita? Eh may nakarinig... mo?!? Nakakadiri ang trip!!! CALOY: Takpan mo mata mo. Ano ang Ano naman ang silbi ng may katabi, nakikita mo? kung wala namang nangyayari. Beauty Secret ROMMEL: Wala… Eh may humirit... CALOY: O, ‘di nakakita ka ng wala. Eh ano naman kung may nangyayari LUZ: Simple lang naman ang formula kung wala namang nabubuong baby. para sa isang successful na Homeless Eh may affected... marriage... Paanong may mabubuong baby kung EDNA: Ano 'yun, Mare? TONIO: 'Pre, anong tawag sa kuto pareho kayong lalaki. LUZ: Dapat may beauty secret ka na nasa ulo ng kalbo? Eh sumagot ng bakla... para 'yang Mister mo hindi PAKING: Hindi ko alam... Ano nga ba? Aanhin mo naman ang babae, magkaroon ng secret beauties. TONIO: Eh, 'di HOMELESS. kung mukha namang lalaki!
36 HEALTHbeat I January - February 2014 QUALITY management
TOP: President Benigno S. Aquino III (second from left) witness the awarding of the department-wide Quality Management System to Health Secretary Enrique T. Ona (extreme right) conferred by the Certification International, Philippines (CIP) at the Heroes Hall, Malacañan Palace on December 18, 2013. ABOVE: DOH Executive Committee members and some Central Office directors (left photo) and directors of regional health offces and hospitals (right photo) pose with the President. (Photos by Paking Repelente) DOH-wide ISO 9001:2008 Certification President Benigno S. Aquino III single ISO 9001:2008 certification conferred mean to the ordinary Filipino? Simple, this recognized the Department of Health the by the Certification International Philippines, reform will ensure faster, more efficient prestigious ISO 9001:2008 certification in a Inc. (CIP). health services for our people. The stricter ceremony held at the Heroes Hall, Malacañan Aquino said the DOH-wide standards will improve our processes Palace on December 18, 2013. The DOH ISO 9001:2008 certification is another involving documentation, planning, becomes the first government agency under concrete sign of the government’s positive monitoring and feedback in rendering the executive branch to have a department- transformation during his administration. quality services to our people.” wide Quality Management System under a He quipped: “What does an ISO certification Having an ISO (International
January - February 2014 I HEALTHbeat 37 Organization for Standardization)- DOH targets 64 more DOH hospitals to be Philippine and multinational companies certification means that an agency ISO-certified by 2015. But he challenged the who are leaders in their respective industry or company strictly ensure that their DOH, “Kung gusto niyong 2014, okay rin po or service sector. CIP is also the certifying management systems operate effectively sakin ‘yan. (If you want it in 2014, that’s very body of majority of government offices and as a guide for achieving their organizational fine with me.)” institutions. performance goals, such as commitment to For his part, Health Secretary The DOH journey to ISO certification quality and client satisfaction. Enrique T. Ona declared, “Being ISO-certified started with a March 2011 launching. In The DOH is described by the CIP as is a step towards excellence,” adding that April of the same year, the agency engaged “the single department-wide and biggest the certification means that the DOH is now the technical assistance of the Development agency under the executive branch to be deemed efficient and was able to minimize Academy of the Philippines (DAP) to develop certified,” even by other certifying bodies in wastage in time, effort and resources and a Quality Management System (QMS) by the country, both in the public and private eliminate unorganized and unnecessary August. Then in September, the QMS was institutions. This certification covers all 17 processes. implemented in all offices with the assistance different bureaus and offices in the Central The DOH ISO-certification is of DAP. On July 17, 2012, the DOH Central Office, the Food and Drug Administration the result of the collective effort of each Office’s 17 bureaus, centers and services of and the 16 regional health offices (called and every individual throughout the the Central Office and two regional offices Center for Health Development) around the entire bureaucracy, a feat dubbed by the in Metro Manila and CaLaBaRZon were country. Development Academy of the Philippines as certified. Meanwhile, on May 10, 2013, it Aside from the DOH offices, six a Super Quality Management System. was the DOH Food and Drug Administration tertiary care hospitals scattered in the The significance of having a (FDA)’s turn to be certified by TÜV Rheinland archipelago and one attached agency will single ISO Certification to cover the whole Philippines, a provider of technical safety also be awarded. The six hospitals are: Department system is that it now has and certification services worldwide. Region 1 Medical Center (Dagupan City, an integrated yet seamless network of “With the ISO-certification, the Pangasinan), Ilocos Training and Regional processes and systems that make it united. public can expect the DOH to be more Medical Center (San Fernando City, La On the other hand, the challenge of having efficient and more responsive to the health Union), Quirino Memorial Medical Center a single ISO 9001:2008 Certification is that, concerns and needs of the Filipino citizenry (Quezon City), Philippine Children’s Medical the success of one is the success of all, yet the which is the purpose and intention of Center (Quezon City), Mariano Marcos opposite is also true because the failure of Kalusugang Pangkalahatan (Universal Memorial Hospital and Medical Center one office will affect the entire bureaucracy. Health Care),” Ona concluded. (Batac City, IlocosNorte), and Rizal Medical The CIP has been in the Philippines The President, however, asked the Center (Pasig City). The lone attached agency since 1995 and is an affiliate of the British DOH not to be content with its achievement, is the Food and Drug Administration. company Certification International U.K. and it should continue its efforts to improve The President announced that the Ltd. It has since certified more than 900 its service.
February 28, 2014 is announced as the last working day for Department of Health personnel who opted for retirement in the Rationalization (Rat) Plan. HEALTHbeat wishes you all a happy, healthy and productive life!
38 HEALTHbeat I January - February 2014 Muslim HEALTH Innovating CSC-ARMM Form 211 NCD Metrologies in Medical Certificate for Government Employee Entrants by TATO M. USMAN, MD, MPAIM DOH - Autonomous Region in Muslim Mindanao
Major non-communicable diseases and timely treatment in a primary health Treatment Pack). (NCDs) – stroke, heart disease, cancer, care setting named WHO Package of In 2012, Department of Health diabetes and chronic lung disease –are Essential Noncommunicable (PEN) Disease likewise issued Administrative Order No. among the 10 leading causes of deaths Interventions for Primary Health Care in 0029 adopting the WHO PEN and renamed locally, nationally and globally. In fact, Low-Resource Settings. it as Phil PEN. In 2013, Philippine Health UN Secretary General Ban Ki Moon stated, In 2011, the Department of Health Insurance Corporation (PhilHealth) issued its “Cancer, diabetes, heart diseases are no issued Administrative Order No. 0013-A to Circular No. 0020 adopting the Phil PEN. longer the diseases of the wealthy. Today, increase patient’s access quality essential The DOH-ARMM has already they hamper the people and the economies medicines to include drugs for NCDs conducted five batches of Phil PEN training of the poorest population even more than otherwise known as ComPack (Complete and distributed glucometers, cholesterol infectious diseases. This represents a public health emergency in slow motion.” In many countries, however, cost- effective interventions, both population- wide and high-risk approaches, exist and have worked using the World Health Organization (WHO) causation and intervention pathways. • In Japan, reduction of salt intake resulted in lower blood pressure (BP) and great reduction in stroke deaths. • In Poland, changed in dietary fats resulted in 20% decline in heart disease deaths. • In Mauritius in Africa, changing cooking oil from palm to soya resulted in 15% decrease in serum cholesterol in the population. • In North Karelia Project, Finland, over 25 years, a community-based activity encouraging a healthier diet reduced annual heart disease deaths by 73%. In 2010, the WHO endorsed a set of low-cost individual treatment From the cover of the World Health Organization publication on the Package of Essential protocol consisting of early screening Noncommunicable (PEN) Disease Interventions for Primary Health Care in Low-Resource Settings
January - February 2014 I HEALTHbeat 39 meters and other portable medical gadgets to mitigate the state of epidemic on NCDs due to unhealthy lifestyle such as tobacco for dry chemistry tests. Two batches of this in slow motion as quoted from the UN use, alcohol use, physical inactivity and training were conducted in Manila, and Secretary General the member states will unhealthy diet. dovetail them to the tw-day Seminar on remain in a state of epidemic. In an authentic Hadith, the Urinalysis: Maximizing the Use of a Basic In reality, Allah Almighty created Prophet Peace be upon him),said: “There are Tool for the Diagnosis and Prevention of human in healthy condition but it is the two blessings forgotten by people: health Kidney Diseases under the Renal Disease human that chooses lifestyle leading to and time.” Control Program (REDCOP) of the National unhealthy condition. As a matter of fact, Allah Almighty knows best. Kidney and Transplant Institute (NKTI). The NCDs are considered human-made diseases - o O o - first day was devoted to observation and study tour on different NKTI laboratories and interaction with patients having dialysis. The second day was more on didactic lectures and case study exercises. During these seminars, the ARMM participants were given hundreds of 10-parameter dipstick urinalysis strips for them to implement what has been learnt in diagnosing the 10 clinical syndromes in nephrology. Late last year, DOH-ARMM issued Department Memorandum No. 2767, s. 2013 to all provincial health officers and government physicians in ARMM to adopt the newly revised Civil Service Commission (CSC)-ARMM Form 211 for medical certification of government employee entrants. This form was enriched to include the Phil PEN metrologies such E R R A T U M as blood glucose, total blood cholesterol, 10-parameter dipstick urinalysis, body mass index (BMI), waist circumference, and waist Right Photo, Wrong City to hip ratio (W-HR) among others. The DOH-ARMM also issued In the Special Edition on Breastfeeding (October 2013) for the Department of Department Circular to all line agencies Health-National Capital Region (DOH-NCR), HEALTHbeat seemingly found the right in the region to adopt the aforesaid CSC- photo above for the article on page 39 that we titled "Gatas Mo, Buhay Ko" about the ARMM Form. This is expected to be fully simultaneous breastfeeding cum breastmilk donation in two districts of Caloocan City implemented starting 2014. held on August 31, 2013. However, the DOH-NCR called our attention on the mistake we In the Noble Qur’an, Chapter 13, made because the photo rightfully belongs to Valenzuela City which was taken during The Thunder, Verse 11, Allah Almighty says: the simultaneous CAMANAVA breastmilk-letting activity in October 2012. With the “Verily, Allah will not change the condition hundreds of photos submitted to us by the 17 local government units of Metro Manila, of a people as long as they do not change we slipped with our choice. Sorry about that Dr. Jaime M. Exconde, officer-in-charge their state themselves...“ of Valenzuela City Health Department. We hope that this erratum will rectify some It can be deduced from this confusion. verse that if the people will not change - The Chief Editors or do something effective interventions
40 HEALTHbeat I January - February 2014 consumer HEALTH
Facts About Aflatoxin
Molds in food may cause cancer. in humans in Africa and Asia where peanuts Although aflatoxin makes peanuts This is what the Department of Health-Food are a dietary mainstay. Recent research taste bitter, some unscrupulous food and Drug Administration (FDA) said in its has shown a strong association between processors or peanut vendors simply mix advisory on “Consumer Information on Food long-term dietary aflatoxin exposure bad peanuts with good ones rather than Products Contaminated with Carcinogenic in conjunction with hepatitis B (a viral throw them out. Diluting contaminated or Aflatoxin” dated January 22, 2014, in time infectious disease of the liver) and increased adulterated raw or food ingredients with for the National Cancer Consciousness Week. rates of liver cancer. non-contaminated or unadulterated ones Aflatoxin is a naturally occurring Humans are exposed to aflatoxins in order to comply with the acceptable contaminant produced by mold, particularly by ingesting contaminated foods. Since regulatory limits of the FDA or the Aspergillus flavus and Aspergillus parasi- aflatoxins are widespread in nature, the FDA international market is prohibited under ticus. These molds grow on crops, especially permits low levels of exposure, meaning Republic Act (RA) 3720 (The Food, Drugs and peanuts, stored under conditions of warmth not going beyond the acceptable limit of 20 Devices, and Cosmetic Act), RA 9711 (The and humidity. parts per billion or ppb (ug/kg). FDA Act), and RA 7394 (The Consumer Act of Aflatoxin is also known as an “anti- Aflatoxin may be an “unavoidable the Philippines). nutritional” or “anti-nutritient” toxin because contaminant,” but sampling and testing The FDA warns all food manu- it binds proteins, vitamins and minerals so of peanut-based products for the level of facturers against processing aflatoxin- that the body cannot absorb the nutrients. In aflatoxin by importing countries are routine contaminated or adulterated raw ingre- children, aflatoxin can stunt growth and can activities around the globe. When Philippine dients into finished products. It also strongly lead to kwashiorkor – a debilitating disease products fail the test and these are shipped advises the public to buy only FDA-registered of nutritional deficiency. If ingested over a back to the country, it becomes a source of pre-packaged peanuts and other grain prolonged period of time in large doses, the embarrassment in the arena of international products, including milk products, from FDA- poison can inhibit the immune system. With trade. It affects the credibility of Filipino licensed food manufacturers. prolonged cell exposure, aflatoxin causes food companies, and it undermines the Likewise, the FDA warns of the mutation of cell DNA (deoxyribonucleic confidence of consumers on agencies like possibility that the peanuts sold or offered acid) which is responsible in encoding the the Department of Agriculture and the FDA. for sale by ambulant and street vendors, genetic instructions for the development The FDA-Center for Food Regulation who are under the purview of local and function of cells, tissues and organism. and Research laboratory is regularly government units, contain aflatoxin beyond The mutations cause by aflatoxin increase testing several pre-packaged peanuts the allowable limits. The agency encourages the risk of developing cancer cells. both imported and locally manufactured. the public to report unscrupulous and Aflatoxin B1 has been classified as It is also conducting systematic audit of unlicensed food processors or manufacturers a known human carcinogen and is known manufacturers for compliance with the and unregistered food products through to cause liver cancer in animals. Aflatoxins current Good Manufacturing Practice and email at
January - February 2014 I HEALTHbeat 41 consumer HEALTH Tips on Healthy Eating The Department of Health-Food longer or increase the shelf life, b) to make eliminate them. There are food products that and Drug Administration (FDA), issued its it more palatable or tastier, or c) to prevent appear to be “junk” or “empty in calories,” first public advisory for 2014 on healthy food from spoiling. Different methods are but are actually good sources of other eating. Dr. Kenneth Hartigan-Go, FDA acting used to preserve food, such as cooking, micronutrients, such as calcium or potassium director, said that people often blame canning, drying, irradiation, chemical food that are also important in maintaining good processed food products in the market as the preservation, and fermentation. health. primary cause of obesity or chronic diseases, Some processed foods are high Finally, Go advised consumers to such as hypertension or diabetes. But this in salt, sugar, fat or caloric content. He remember or observe the following: is only part of the problem. They have, in advised consumers to read the nutritional fact, coined the word “junk food” or “empty information on the label, such as the 1. Sugar or fat can increase weight calories” to mean specifically processed food number of calories per serving, the number when the caloric intake from sugar that offer little protein, vitamins or minerals, of grams of fat, the level of sodium added, or fat is more that what the body but have lots of calories from sugar or fat, or the level of cholesterol, or sugar content. This needs. are high in salt. nutritional information helps consumers to 2. Never be influenced by advertise- However, Go pointed out that there reduce their nutritional health risks. They ments or promotional gimmicks. are some fresh food that may also fit in the should watch out for calories to manage Read the product nutritional label or definition. FDA-registered processed food their body weight. They should watch out nutrient content on the label. products are labelled with the ingredients for sodium and cholesterol to reduce the risk 3. Diversify your diet and eat a or with nutrition facts to guide consumers of hypertension. Lastly, they should watch balance meal. Eat enough rice, in their choice of food. He said, the problem out for sugar levels in their food to prevent bread, fruit, vegetables, meat, fish, really is the choice people make to their acquired diabetes. poultry, vegetables, and fruits. Eat unhealthy eating habits. Sodium, cholesterol, and sugar food in moderation. Go explained the different reasons are all part of the normal diet of healthy 4. Drink enough water to quench why fresh or raw agricultural products people. People should watch out for serving your thirst. For proper metabolism are processed and pre-packaged by food sizes rather that deprive themselves of their and to promote exertion of wastes manufacturers, including: a) to store food favorite food. Limit food intake rather than from the body.
Art by Antonio Totto, Jr.
42 HEALTHbeat I January - February 2014 KALAbeat Dami Kong Tuwa Pinakasalan ng babae ang kanyang kasintahan. Pagkatapos Isang araw, kinausap ni Misis ang kanyang ina at sinabing, ng selebrasyon, ibinigay ng kanyang ina ang isang "Ma, hindi ko na siya matiis! Napagpasyahan kabubukas pa lamang na savings passbook ng na namin na kami'y maghiwalay." Ang isang banko na naglalaman na ng P25,000. tugon ng kanyang ina, "Okay, wala na Ang sabi ng ina, "Anak, tanggapin mo naman akong magagawa kung iyan itong passbook at gawin mo itong record ang desisyon ninyo. Isa lang ang gusto o talaan ng inyong pagsasama bilang kong gawin ninyo bago kayo tuluyang mag-asawa. Kapag may maghiwalay. Naaalala mo ba 'yung masayang nangyari savings passbook na ibinigay ko sa araw sa iyong buhay, ng kasal ninyo? Isarado mo muna ang magdeposito ka ng pera bank account na iyon at gastusin at isulat mo sa tabi nito mong lahat ang laman. Hindi ang dahilan. Lakihan mo na dapat ipinagpapatuloy ang halaga ng deposito ang account na iyon dahil hindi sa mga pagkakataong labis ang naman naging maayos ang inyong kaligayahang natanggap. Ginawa pagsasama." ko na ang unang deposito para sa iyo Sumangayon si Misis sa kanyang ina. ngayon. Gawin ninyong mag- Pumunta siya sa banko at habang asawa ang mga susunod na nakapila at naghihintay para deposito. Sa paglipas ng panahon isarado ang kanyang account, binuksan at babalikan ninyo ang passbook na ito, malalaman ninyo kung niya ang passbook at binasa ang mga nakasulat dito. Unti-unting gaano karaming kaligayahan ang inyong pinagsaluhan." nanunumbalik ang alaala ng masasayang araw nilang mag-asawa. At sinabi ng babae ito sa kanyang asawa. Napagkasunduan Naiyak siya at hindi na maatim isarado ang account at siya ay umuwi nilang dalawa na ipagpatuloy ang magandang ideya na ito. Hindi sila na lamang. makapaghintay sa susunod nilang deposito. Lumipas ang mga araw Sa bahay, ibinigay ni Misis kay Mister ang passbook at at ito ang naging anyo ng kanilang passbook: sinabi niyang siya na lamang ang magsara ng account at gumastos 7 Feb: P 2,000, unang birthday celebration ni ng laman nito. Mister bilang may asawa Kinabukasan ay pumunta si Mister sa banko at habang 1 Mar: P 5,000, nakakuha si Misis ng increase nakapila ay binasa niya ang lahat nang nakasulat sa passbook at sa kanyang sahod napaluha. Matapos ang ilang sandali, umalis na siya ng banko at 20 Mar: P 3,000, bakasyon sa Bali, Indonesia umuwi. 15 Apr: P10,000, buntis si Misis Inabot ni Mister ang passbook sa kanyang Misis at 1 Jun: P 5,000, na-promote si Mister nang buksan niya ito ay nakita niyang may bagong deposito na at iba pa... nagkakahalaga ng P50,000. At sa linya nito ay may nakasulat din na: Subalit, habang lumilipas ang panahon, nagsisimula nang "Ito ang araw na aking napagtanto kung gaano kita kamahal at kung magtalo at mag-away ng mag-asawa kahit sa mga maliliit na bagay gaano karaming ligaya ang ibinigay mo sa akin nitong mga nakalipas lamang. Hindi na sila nakakapag-usap ng masinsinan at unti-unting na mga taon." na nilang pinagsisisihan na pinakasalan nila ang isa't isa. Wala nang At naiiyak na niyakap ni Misis si Mister. Itinabi na nilang pag-ibig sa pagitan ng mag-asawa. muli ang passbook.
(Ito ay halaw sa kwentong lumabas sa Internet; isinalin lamang sa Filipino ng HEALTHbeat para magmukhang orihinal. Hahaha.)
January - February 2014 I HEALTHbeat 43 laughter HEALS PAG-IBIG SA PANAHON NG KRISIS Sad Love Timeless Love Love Millionaire
Saddest Love Story Ever MACON: Anong gusto mong gift sa BETCHA: Kung naging milyonaryo ka lang, RIA: Huhuhu! Valentine's Day? pagtitiyagaan kitang maging RUBEN: Huhuhuhu. NEIL: Relo. nobyo kahit ganyan ang itsura -The End- MACON: May relo ka pa naman, ah. mo. NEIL: Eh kasi, sinira mo ang relo ko eh. REX: Kung naging milyonaryo ako, Brief Love MACON: Ha? Paano ko sinira? sinisiguro ko sa iyo na pipila ka! NEIL: Tuwing kasama kasi kita, JOEREM: Alam mo, para kang brief ko... tumitigil ang oras ko. Love in a Can LENI: Excuse me?!? JOEREM: Kasi, halata man o hindi, Angry Love EMAN: Araw-araw nalang sardinas pakiramdam ko ay kulang pa ang pinapakain mo sa akin. rin kung wala ka. MAY: Hoy! Harapin mo ako! ELLEN: Huwag kang mag-alala, love. ED: Ayoko! Marunong na akong magluto Love Smile MAY: Harapin mo ko sabi, eh... ngayon. ED: Ayoko nga ! EMAN: Talaga?. BOY: Nakalunok ka ba ng kwitis? MAY: Ba't ba kapag nagagalit ka, ELLEN: Oo. Natuklasan kong mas AILEEN: Bakit naman? tumatalikod ka? Bakla ka ba ? masarap pala ang sardinas BOY: Kapag ngumiti ka kasi, ED: Mamaya na! Nawawala kasi kapag iginisa. may spark! ang galit ko pag kaharap kita! Stupid Love Love Angel Joke Love JOJI: Walanghiya ka! Magpapakamatay FRED: I want to be your angel who’ll MICHAEL: Isa kang JOKE! na talaga ako kapag mahuli ulit guide, follow, and love you.. FRANCES: Huh?!? kitang nambababae. JOYCE: Weh, talaga? MICHAEL: Pinapasaya mo kasi ang bawat DANNY: Magtigil ka nga! Sampung taon FRED: Oo naman, kaya lang, how can minutong kasama kita. mo nang sinasabi sa akin 'yan, I be an angel kung sa ngiti mo hindi mo naman ginagawa. pa lang, nadedemonyo na ko?!? Love Comics Undying Love Dog Love BOY: Sagutin mo lang ako, ibibigay ko sa iyo ang buwan at mga EDMOND: Love, kapag namatay ako, mag- JOJO: Ano, naniniwala ka na sa akin na bituin. asawa ka ulit agad. Si Dennis hindi mo mapapasunod sa gusto GIRL: Hmp. Nabasa ko na iyan sa ang gusto ko. mo ang bagong aso natin. komiks ah. ABBY: Kaaway mo 'yun, ah! ROSE: Huwag kang mainip. Nahirapan BOY: Oo nga. Sa 'yo ko nga hiniram EDMOND: Kaya nga gusto kong magdusa din naman ako sa iyo nung una. 'yung komiks, eh. rin siya, eh.
44 HEALTHbeat I January - February 2014 DISASTER preparedness This Page is On Fire
Fire is FAST. In just two minutes, a fire history are the Manor Hotel fire in August to regularly check and maintain can become life-threatening. In five 2001 with 70 casualties and the Ozone electrical installations. minutes, a residence can be engulfed in Disco tragedy in March 1996 leaving at • Do not overload extension cords or flames. least 162 people dead, many of whom were outlets. Inspect cords for frayed or high school and college students attending exposed wires or loose plugs. Fire is DARK. Fire produces gases that graduation or end of the school year make you disoriented and drowsy. celebrations. In the Manor Hotel fire, only • Unplug appliances after every use. Instead of being awakened by a fire, one died of severe burns but the rest died • Never leave cooking unattended. Keep you may fall into a deeper sleep. of suffocation. In the Ozone Disco fire, all towels, pot holders and curtains away Asphyxiation (suffocation) is the casualties were completely burned. In both from flames. leading cause of fire deaths than burn. incidents, the victims were trapped because of the lack of fire exits. • Do not leave lighted candles, gas Fire is HOT. Heat and smoke from fire Both fire incidents underscored lamps and mosquito coils unattended. can be more dangerous than the flames. the two most common risks associated with • Store or dispose properly matches, Inhaling the superhot air can destroy fire: burns and asphyxiation due to smoke flammable liquids, lighters, and other your lungs. Other risks to health are trauma and injury combustible materials. Keep these from falling debris. These are the three basic charac- materials away from the reach of March is Fire Prevention Month in teristic of fire for you to understand and children and even pets. the Philippines because it marks the start protect yourself. Death and injury are the of the hot, dry season during which most • If you must smoke, do it responsibly. greatest risk of fire. The causes of fire are fires occur. However, fire incidents are plenty Never smoke in bed or when drowsy related to everyday living which is quite too in December, the improper connections or medicated. Don’t throw lit cigarette impossible to change. In the Philippines, of Christmas lights as well as firecracker/ butts on dried leaves, garbage, and the top five causes of fire are faulty electrical fireworks add up to the major causes of fire. other flammable materials. connection, combustible material (match, candle, gas lamp, mosquito coil), electrical • Have an escape plan. Review escape Before Fire appliance, cooking equipment, and lighted routes with your family. Make sure cigarette. • Maintain proper electrical connection. windows are not nailed or locked. In Fire can wipe out blocks of houses Overloading and worn-out wiring high-rise buildings, never lock fire exits and other of properties, but its effect on can lead to short circuits or doorways, halls or stairways. Teach human lives cannot be (critical ignition family members to stay low to the floor, overestimated. Two of the point of electrical where the air is safer, when worst fires in Metro systems). Have a escaping from a Manila in recent licensed electrician fire.
January - February 2014 I HEALTHbeat 45 During Fire rags, bedding or tape and cover vents to After Fire keep smoke out. • Do not panic. Get out of the house • Once you are out of the house or a immediately and call the Fire • When escaping a fire, if the door is cold building, STAY OUT! Do not go back Department. slowly open it and ensure that fire and/ inside for any reason. or smoke is not blocking your escape • When escaping a fire, check closed route. If the escape route is blocked, • If you are with a burn victim or are doors with the back of your hand to shut the door and use another escape a burn victim yourself, seek medical feel for heat before you open them. If route. If clear, leave immediately and attention immediately. Cool and cover the door is hot do not open it. Find a close the door behind you. Be prepared your burns until emergency units arrive. second way out, like a window. If you to crawl. • Tell the Fire Department if you know of cannot escape through a window, hang anyone trapped in the building. a white sheet outside the window to • If your clothes catch on fire, you should alert firefighters to your presence. Stuff stop, drop, and roll until the fire is • Only enter when the Fire Department the cracks around the door with towels, extinguished. tells you it is safe to do so. Burn
Burn is a type of injury to flesh The assessment of the extent of caused by open flame, hot liquid or stream, the damage due to burn, or how much body friction, electricity, radiation, contact with surface is affected is best done by using the hot object, chemicals, or from explosions. Rule of 9. In this method, the body surface is Managing burn injuries properly is crucial divided into percentages. (See illustration.) since it is painful, disfiguring and disabling. Quick response to burn victims in Complications may be experienced such as the first few minutes after it occurs can make shock, infection, multiple organ dysfunction a big difference in the severity of the injury. syndrome, electrolyte imbalance, and When victim is literally on fire: “Stop, Drop, respiratory distress. and Roll” to put out the flames. Take away all The treatment of burns will burned clothing because it can adhere to the depend on seriousness of the tissue damage burned skin. Get rid of all jewelry, belts and and its extent. Burns are classified according tight clothing from over the burned areas to seriousness of tissue damage. and from around the victim’s neck because RULE OF 9 - a formula for estimating the burned areas will swell immediately. • FIRST DEGREE –redness and swelling percentage of adult body surface covered by For first degree burns, immerse in the outermost layer of the skin, and burns by assigning 9% to the head and each arm, in cool, fresh water or place cool, wet painful to touch. twice 9% (18%) to each leg and the anterior and compresses on the burn until pain subsides. • SECOND DEGREE – redness, swelling posterior trunk, and 1% to the perineum. This is Wrap/cover the burn with a sterile, non- modified in infants and children because of the and blistering, and damage extended to proportionately larger head size. Grabbed from adhesive bandage or clean cloth. Do not the cutaneous layer of the skin. Some
46 HEALTHbeat I January - February 2014 CLIMATE effects Severe Heat
Temperature usually rises in the Philippines in March and lasting for three months or maybe more. We do not know what will happen to our dry season or what most Filipinos have already termed as "summer," now that we are experiencing unpredictable weather due to the effects of climate change. For sure though, hot and humid conditions add to the discomfort of high temperatures. Droughts may occur if long period passes without substantial rainfall.
BE PREPARED...
• Increase the amount of water or non-alcoholic drinks that you consume, despite your activity level. Drink before you feel thirsty. Consult your physician if you have a limit on the amount of daily fluid intake or you are taking water pills. • Avoid beverages that contain caffeine, alcohol, or large amounts of sugar. These types of beverages will cause you to lose more body fluids. • When possible, stay inside. If you have access to an air conditioner, use it. Electric fans do not provide relief from heat-related illnesses when temperatures are in the mid 30 0 Celsius and above. • Taking a cool shower or bath is a useful way to cool off. • Wear lightweight, light-colored, loose-fitting clothing. • Never leave people or pets in parked vehicles, especially with the windows closed. • Young children, elderly people, and those who are sick or overweight are at greater risk than others to experience harmful effects of heat.
IF YOU ARE OUT THERE IN THE HEAT...
• Limit your outdoor activity to early morning and evening hours. • Limit exercise. Be sure to drink at least two to four glasses of cool liquids every hour. • Frequently take breaks under shady areas. • There are a number of ways to protect yourself from the sun. Use an umbrella or wear hat, sunglasses and sunscreen that is SPF 15 or higher (the most effective products say "broad spectrum" or "UVA/UVB protection" on their labels).
Heat stroke is the most serious heat-related disorder. It occurs when the body becomes unable to control its temperature: the body's temperature rises rapidly, the sweating mechanism fails, and the body is unable to cool down. When heat stroke occurs, the body temperature can rise to 41 0 Celsius or higher within 10 to 15 minutes. Heat stroke can cause death or permanent disability if emergency treatment is not given.
The symptoms of heat stroke include: hot, dry skin or profuse sweating; hallucinations; chills; throbbing headache; high body temperature; confusion/dizziness; and slurred speech. Help a person who might be suffering from heat stroke and take the following steps: call for medical assistance immediately; move the sick person to a cool shaded area; soak his/her clothes with water; spray, sponge or shower him/her with water; fan the body.
People with the following conditions are especially prone to heat stroke: alcoholism; chronic illnesses like heart disease; obesity; uncontrolled diabetes; Parkinson’s disease; older age; use of certain medications such as diuretics and antihistamines; and use of some illegal psychoactive drugs such as methamphetamine (shabu, in the Philippines).
January - February 2014 I HEALTHbeat 47 men's HEALTH Under My Umbrella
In the Philippines, men have embraced the a tropical country where parasol in efforts to stay there are only two seasons, cool, collected, and not the wet and dry seasons, it sweaty – the result of is very common to see men power conservation efforts using umbrellas to protect post-Fukushima, hotter- themselves from rain, but than-usual summers, and not from the sun which is sheer practicality. The considered unmanly. This Takashimaya department stereotypical attitude is store chain claimed, not only happening in the “There's been a spike in country but throughout the demand for men's sun globe dating back to ancient umbrellas of about three times. times since the previous But did you know summer. Most of them buy that the umbrella was it for business when they originally used to protect have to step outside of the people from the SUN.? office to go to a meeting. People have been using They feel that it's rude umbrellas for thousands of to show up to work or a years to protect them from meeting all sweaty and the sun and its heat and worn out from the heat.” only a few hundred years for And last year, a study by rain protection. Although in Dermatologists at Emory Ancient Greece it is said that University in Atlanta says umbrellas were first used by the umbrella could help women in the 5th century BC shield skin from ultraviolet and men did not use them (UV) rays. The researchers as they were not considered found that any fully- to be manly enough, in (Photo by Frederick C. Pereňa) functioning handheld other places, culture and umbrella can block more time, the umbrella has been a symbol of new island. Why? To show his authority. On than three-quarters of UV light on a sunny power in men. the other hand, some British soldiers took day. Choose black umbrellas especially Ancient Egyptians believed the umbrellas with them into the battles of the because these seem to do the job well, by sky was the underbelly of a god that looked Napoleonic wars in the early 1800s until the blocking at least 90 percent of rays. like a giant umbrella. Thus, the Pharaohs British military decided that they were not In the scorching heat the and other notable people were often seen a fitting image for fighting soldiers. Now, Philippines is experiencing at the height of under the shade of an umbrella. In the 1400s many men refuse to use the umbrella under the dry season, a practical advice for men is sailors from Portugal that were destined the sun. to use the umbrella. Now guys, would you for the East Indies carried an umbrella over But that may be changing. In dare use one for your health? their captain's head when they landed on a 2011, Reuters reported that Japanese - o O o -
48 HEALTHbeat I January - February 2014 environmental HEALTH Swimming in Polluted Waters Swimming is fun and a healthy exercise or sport especially ingesting, or contaminating open wounds with, polluted water. during summer when the weather is hot. But choose wisely the Viral Gastroenteritis is the most common illness associated places you would want to dip your body. with swimming in polluted water. Although the symptoms are Manila Bay has become a popular destination of people usually minor, they may present in a variety of forms that can include who cannot afford to go to resorts and beaches. Sadly, the Manila one or more of the following: chills, nausea, diarrhea, stomachache, Bay and several other bodies of water in the country are full of headache and fever. wastes coming from urban and industrial development, farming, Other illnesses that result from swimming in polluted animal-feeding operations, mining, combustion of fossil fuels and water include diseases affecting the eye (sore eyes or conjunctivitis), even faulty sewage systems. National and local governments should ear (otitis media or impacted cerumen with or without hearing loss), issue advisories against swimming in thes areas. But even public skin infections (fungal, bacterial or toxic from human and industrial swimming pools and jacuzzi hot tubs are not without health risks, wastes). therefore owners should ensure that their facilities are regularly In highly polluted water swimmers may be exposed to cleaned, filtered and disinfected to prevent diseases. more serious diseases like amoebic dysentery, cholera, giardiasis Small children, infants, (a protozoan infection), hepatitis, intestinal parasites, shigellosis the elderly, and those with (intestinal infection caused by bacteria that can give a person bloody compromised immune systems diarrhea and cause intestinal pain), schistosomiasis, leptospirosis, are most likely to develop illnesses and viral respiratory infections. or infections after swimming in, - o O o -
Mag-ingat sa pagsakay ng jeep lalung-lalo na sa gabi...
Isang gabi sumakay ako ng jeep. Lahat ng pasahero hindi, pagsisisihan mo ang pwedeng mangyari sa iyo. Hindi ka na nakatitig sa akin. Walang umiimik. Napaka-weird man ang aking makakauwi sa inyo!" naramdaman, hindi na ako bumaba. Napalunok ako. Pinagpawisan ng malapot at sumagot, Dahil nakasanayan ko namang magbayad pagkasakay "Ano po ang ibig ninyong sabihin?" At ang sagot niya, "INARKILA inilabas ko ang bayad ko at sinabing, "Ma, bayad po, sa NAMIN TO. MAGNA-NIGHT SWIMMING KAMI! TANGA KA BA?!?" Sandiganbayan lang." Pero lahat nakatingin pa rin sakin. Wala pa ring umiimik. Yung isa bumulong sa kanyang katabi. Naiirita kong sinabi: "Pwede pong paki-abot ng bayad ko?!? Pero, lahat sila nakatingin pa rin sa akin. Maya-maya, may isang matandang babae ang umusog palapit sa akin at bumulong, "Hindi ka na dapat na naparito, iho.
Umalis ka na habang hindi pa nakakaalis itong sasakyan. At kung Artwork grabbed from
January - February 2014 I HEALTHbeat 49 SAbeat
CLINIC HOURSClipart grabbed from
Iron Deficiency Masakit Ba? Mid-Life Crisis
Isang medical intern na gusut-gusot ang DOK YUL: Aalisin ko ang eyebags mo. DOK MARWIN: Ano po ang pangalan nila? uniform ang na-late at nagmamadaling Lalagyan ko ng bridge ang LELAY: Aleli Beltran po. pumasok sa emergency room. Pinuna siya ng ilong mo. Babawasan ko ang DOK MARWIN: Ah, oo. Natatandaan ko nga medical consultant... panga mo, enhance ko ang kayo. Ilan taong gulang na? DOK JIMMY: Dr Asuncion, may IRON lips mo at papaputiin kita. LELAY: Eksaktong 35 na po. deficiency ka! AILEEN: Eh Dok, masakit po ba iyon? DOK MARWIN: Aba'y apat na taon na DOK YUL: Mararamdaman mo lang naman pong ganyan ang sinasabi Sosyal at Sexy ang sakit kapag nakita mo na ang ninyong edad sa akin. bill na babayaran mo. LELAY: Aba, Dok. Hindi ako Isang sexy at sosyal na pasyente ang pumasok katulad ng ibang babae sa clinic para magpakunsulta... Successful ang Operasyon d'yan na pabagu-bago ang BAMBI: Doc, I'd like to get something isip at sinasabi. Ako po ay off my chest... DOK IVAN: Successful ang operasyon. Ito mayroon isang salita. DOK FRANK: And, what's that, iha?!? ang salamin, maaari mo nang BAMBI: Your eyes, po. tingnan ang iyong sarili. Nursery JOEL: Waaaaaaaaaaaaah. Check-Up Muna DOK IVAN: Bakit ka sumigaw at parang DOK ANTHONY: Mister, pwede mo na kang natakot? pong tingnan ang baby DOK ERNIE: Maaaring kailanganin mo lang JOEL: Bakit ako naging babae? mo sa Nursery, sa may ng aspirin o kaya naman DOK IVAN: Hindi ba ikaw yung gustong 2nd Floor. ay bypass surgery. Kaya magpa-sex change? RENATO: Paano ko naman po siya magsagawa ako ng thorough JOEL: Dok, naman! Magpapatuli makikila. eh ang daming check-up. lang sana ako! bata 'dun?!? RAYMOND: Anong check-up, Dok? DOK ANTHONY: Pambihira, sarili mong DOK ERNIE: Kailangan kong i-check ang Hotcake anak hindi mo kilala? bank account at credit rating mo kung kakayanin mo nga LITA: Dok, anong gagawin ko sa Hahaha ang bypass. anak ko? Ang liit ng ari niya? DOK NITOY: Madali lang yan, Misis. EDWIN: Dok, gusto kong bilhin ang Reseta Pakainin mo ng hotcake. nireseta ninyong gamot para Kinabukasan sa agahan, nagluto si Lita ng tuluyan akong gumaling, ADEL: Dok, ano po ang gagawin ko sampung hotcake. pero wala po akong pera. dito sa resetang ito? JEFF: Wow, ang daming hotcake! DOK ALAN: Hahahahaha! DOK MEME: Inumin mo 'yan! LITA: Ops, ops, ops... Tatlo lang EDWIN: Bakit po kayo tumatawa? ADEL: Hindi po kaya mahirinan ang sa 'yo d'yan. Pito ang DOK ALAN: Kasi laughter is the best ako dito? sa tatay mo. medicine.
50 HEALTHbeat I January - February 2014