The UP Manila Health and Life Magazine i The UP Manila Health Ripples magazine is published bi-annually by the UP Manila Information, Publication, and Public Affairs Office (IPPAO), 8th floor, Philippine General Hospital Central Block, Tel. nos. 554-8400 local 3842. Contributions are welcome. Please email to [email protected] or send to the IPPAO. EDITOR: Cynthia M. Villamor; EDITORIAL CONSULTANT: Dr. Erlyn A. Sana, PhD; WRITERS: Cynthia M. Villamor, Fedelynn M. Jemena, January R. Kanindot, Charmaine A. Lingdas; Anne Marie D. Alto LAYOUT ARTIST: Anne Marie D. Alto; PHOTOGRAPHER: Joseph Bautista; CIRCULATION: Sigrid G. Cabiling; Contributing Writer: Ernesto O. Domingo, MD ; Josephine D. Agapito Cover Artwork: Anne Marie D. Alto Table of Contents
1 Editor’s Notes
2 Empowering the Filipino Scientist Ernesto O. Domingo, MD
7 Making Significant, Lasting Impact on Public Health Cynthia M. Villamor
13 First Dengue Diagnostic Kit by UP Manila Scientists - Faster, Cheaper, and Proudly Pinoy Anne Marie D. Alto
18 No Cold Feet: A Filipino Scientist’s Journey January R. Kanindot
23 Herbal Medicine: Finding its Niche in Philippine Health Charmaine L. Abing
29 The Philippine Health Information System-Mental Health: Raising Mental Health Awareness in the Country Fedelynn M. Jemena
36 Balik Scientists Tungo sa Kalusugan at Kaunlaran Josephine D. Agapito Editor’s Notes Innovations for Better Health
This issue highlights the role of research in health. The six articles delve into the most important aspects of the environment that feeds research: a conducive and supportive setting or milieu that empowers the scientist, the organizational and physical infrastructure, and the scientist/researcher’s passion and commitment that lead to the high quality and relevance of the researches being undertaken.
As the Philippines’ recognized authority and central body on health researches, the National Institutes of Health (NIH) takes pride in its achievements and contributions to health improvement. NIH researches have been helping Filipinos cope better with illness. NIH researches have been sparing our people from further suffering. NIH researches have been increasing the chances for our people to live longer and better. Let the write-ups talk.
The first article is the keynote speech delivered by National Scientist, University Professor Emeritus and Ramon Magsaysay awardee Dr. Ernesto O. Domingo during the 2015 anniversary celebration of the NIH. The speech focused on strategies and requirements to empower the Filipino scientist which was the theme of the celebration.
With the provision of a conducive environment for research through the NIH as lead agency mentioned by Dr. Domingo in his speech, the next article recounts the development of the Institute from its beginnings in 1996. The article tackles how the NIH has developed into a full-fledged unit and vast network of multi-specialty researchers generating and applying technologies that guide and shape national health policies and programs.
Through its nearly two decades of leadership in health research and development, the NIH has been a driving force behind many innovations and advances that have contributed much to improving the Filipinos’ health. The third article zeroes in on one of such breakthroughs in the field of health diagnostics: the discovery of a cheaper, faster, and more accurate diagnostic kit for dengue that harnesses the power of molecular-based technology to detect the presence of the fatal infection in the first 0 to 5 days of illness. A team led by Dr. Raul Destura is behind this technology.
How did Dr. Destura’s team achieve this and what were the travails the award-winning molecular biologist encountered? The sketch on Dr. Destura will hopefully provide a realistic but encouraging and inspiring portrait of the scientist/researcher as a Filipino in the fourth article.
Featured in the next article are the researches on herbal medicines being done by the Institute of Herbal Medicine (IHM) as it finds its niche in medicine. It also looks into the seeds sown by a team of researchers that are now being built on and further cultivated by the IHM.
Lastly, the article on the Philippine Health Information System-Mental Health Conditions (PHIS-MHC) mirrors the state of mental health disorders in the country. The lack of significant research data affects the planning and development of programs that lead to low government priority for improvement in mental health facilities and personnel. The thick wall of denials by and the stigma on the sufferers and their families make it hard to get proper medical assessment and treatment.
The above are only some of the NIH researches that are advancing the frontiers of health and which have not been amply covered in the previous information materials of the university, the way other NIH research programs have been, such as newborn screening, newborn hearing screening, vision screening, rare disorders, and telehealth.
1 Health Ripples *
Empowering the FILIPINO SCIENTIST*
Ernesto O. Domingo, MD National Scientist, Ramon Magsaysay Awardee, University Professor Emeritus
To empower our scientists and researchers so that they will contribute to nation-building via scientific productivity, an institution like the National Institutes of Health should provide the necessary policies and practices that assure that the scientists can do their work optimally.
DOH Undersecretary Dr. Kenneth Hartigan-Go, UPM Chancellor Dr. Carmencita Padilla, Vice Chancellor for Research and NIH Executive Director Dr. Eva Cutiongco-Dela Paz, PCHRD Exec. Director Dr. Jaime Montoya, UPCM Dean Dr. Agnes Mejia, colleagues, participants, and guests, good morning.
Let me start by greeting the National Institute of Health (NIH) a happy 18th birthday! In human terms, the NIH is one year shy of the end of Dr. Ernesto Domingo with Supreme Court Chief Justice Lourdes Sereno after receiving his Ramon Magsaysay award in 2014 the teen years, a transition point to early adulthood. For about the celebrant as we are wont to do if member of the reorganization people as well as institutions, the NIH were a person. Maybe the story will be committee. And before I this transition requires a lot of accompanied by a video presentation even, proceed any further, I would like stock-taking in order to plan which I am not prepared to do now so bear with to tell you that I have a number for the responsibility-laden me in this short biographical sketch of the NIH. of stories to tell in this talk, years ahead. I surmise that this many personal in nature for occasion is, in fact, part of that Strictly speaking the NIH as a research institution which I beg your indulgence. planning. is actually 28 years old. Here is why: The reason is, like the parable, It would not be amiss to In 1988, with the appointment of a new University a story drives home a point recount to you a short story President, UP Manila was reorganized. I was a without any need for elaborate
* Keynote speech delivered during the 18th Anniversary of the National Institutes of Health of UP Manila, 14th University Science and Technology Week, and 7th Anniversary of the Metro Manila Health Research and Development Consortium (MMHRDC) held on February 17-18, 2016 at the SMX Convention Center, SM Mall of Asia, Pasay City
The UP Manila Health and Life Magazine 2 Dr. Domingo leads the opening of the NIH anniversary exhibits in one of its annual celebrations.
explanation. ISBMR were the following: to all the academic research personnel of the various To resume my story: my task in 1. To house under one roof all the research schools and colleges in UPM the committee was to propose laboratories and facilities in UPM; who may do their research in the policy and the mechanism 2. To functionally and administratively integrate the ISBMR without surrendering for implementation of two all research activities; and their current appointments with major university activities. The their mother units. first was university governance 3. To merge social sciences research with and the second, enhancing biomedical research in recognition of the truism Alas, the physical facility research in the university. that winning the scientific argument does not given to ISBMR, a historical necessarily move people into action. icon of a building, the former Since it was just two years Bureau of Soil of the defunct after EDSA I, we were all still National Science Development intoxicated with the newly Board (NSDB), was woefully recovered freedom and The reason why there is a inadequate for its research democracy, so I proposed a needs. Hence, physical democratized governance Socio in ISBMR is because integration was impossible. system for UP Manila (UPM). it is the social sciences Even if it were possible, the When it was adopted and resistance put up against the implemented, the result was that will move people into move by the already existing a complete disaster. I soon action when the scientific institutes and research learned from this experience laboratories assured that a that the University, by its very argument is won by the bloody conflict with no victor in nature, is ELITIST and that the end will occur. governing it along democratic biomedical scientists. principles as practiced in Events moved on anyway political governance can ruin it. Put in another perspective, this truism implies such that in 1999, under the that good scientific output does not necessarily Presidency of Dr. Emil Javier As to the second assignment, find their way into pertinent policies, which, in and Chancellorship of Dr. I recommended the creation the case of UPM, refers to public health policies. Perla Dizon-Santos Ocampo, of the Institute for Socio- Hence, the need to enlist the help of the social Republic Act 8503, known Biomedical Research (ISBMR) scientists to move people into action. as the “Health Research and as the mechanism for Development Act of 1998”, enhancing research in the It was also envisioned then that the ISBMR will established the National university. The objectives of the have its core staff but its facilities will be open
3 Health Ripples Institutes of Health which took 3. Security for the scientist/ over the ISBMR, lock, stock, and Gone are the days researcher barrel. when scientists have to The necessary tools of research Thus, as I said in the beginning, work in an abandoned begin with the physical space, considering this biography, NIH building if you will, where the is 28 years old, since NIH grew barn or garage. That scientist can work, wherein also out of the ISBMR in the 9th year is housed the equipment and of the latter’s existence. notion is romantic but apparatuses needed for his particular area of investigation. The NIH law enumerated five anachronistic. Gone are the days when (5) objectives of the Institutes scientists have to work in an in Section 4. I would like to of your celebration must be put in place. The abandoned barn or garage. single Section 4e to close question to be answered is: What does it take to That notion is romantic but this short biography. Section empower the scientist in nation-building? I dare anachronistic. In its present 4e states as an objective not claim that I know all the answers, not even location and state, the NIH is of NIH. “To ensure that the most of the answers, but I can certainly identify limping its way into research results of health research and three which I am confident are the foundations because of the less than development activities are upon which the rest of the empowerment adequate tools of research. utilized to improve the health principles are anchored. In fact, I am prepared Its current home which, as of the people.” That precisely to call these three enabling requirements as I mentioned earlier, while of is the reason why there is a primordial because these are the first among the great historical value, is not Socio in ISBMR because it is the many that may be suggested later. designed for present day high social sciences that will move technology research. people into action when the The three primordial requirements I am scientific argument is won by proposing are the following: It is not the same as saying the biomedical scientists. 1. Provision of the necessary tools of research that no effort is being exerted by administration to remedy In order to achieve Section 4e 2. Supportive and enhancing research this deficiency. In fact, our of the NIH charter, the theme environment
Dr. Domingo, with Chancellor Carmencita Padilla and Vice Chancellor Arlene Samaniego, welcomes UP President Alfredo Pascual during the NIH building groundbreaking in July 2016.
The UP Manila Health and Life Magazine 4 Chancellor has a big ticket the same in human cell lines, not embryo. I think of a proposal. Presenting project to address it. We are this simple news report capsulizes the problem it to a bigger group where on the threshold of having a with ethical review. some of the members cannot new and modern research add anything of value to building with state-of-the-art the evaluation may only facilities. Once in place, we The scientist must be able unnecessarily prolong the have answered the first of the 3 evaluation process. primordial requirements. to live decently with the I suggest that the review The second requirement is income he gets from being process also look beyond a supportive and enhancing the stated objectives of the environment for research. a researcher. The scientist research because it can This is a mouthful and I must also have academic happen that approval of the dare not attempt to cover it proposal will result in a bigger comprehensively, assuming I security just like the scientific benefit (though can. unintentional) than mere teacher. attainment of the objective. I will first touch on three specific items under this, As an example, I would like to The problem arises from one very simple items which always come relate a proposal submitted to phenomenon and that is, scientific discoveries up whenever I dialogue with the governing council of the leading to new knowledge and technologies our established and putative Philippine Council for Health that are begging to be applied for the ultimate researchers in the Institutes. Research and Development purpose of improving the human condition, I must say that these issues, (PCHRD) when I was a member outpaces by many years/decades the ethical while existing during the time I of the council. The objective of principles that may be applied to measure the was active in research, do not the proposal was to develop a ethical correctness of such application. Science have the same gravity as they modality of treatment against and Technology always preceed the relevant are now. The three concerns breast cancer in women. The ethical principles. I wonder if Dr. Saul Krugman, are (1) Ethical review of research method uses an antibody who injected inmates of an institution for proposals, (2) Technical homing in on the tumor by mentally-challenged children heat-inactivated review of the same, and (3) carrying lethal chemicals. serum from Hepatitis B carrier persons in order Protected time of the scientist/ Being very well-informed on to demonstrate the effectiveness of a putative investigator. this particular field of study, I vaccine against the virus, will get an ethical told the principal investigator Let me start with the ethical clearance to go ahead, applying present day that their chance of achieving review of research proposals ethical standards which were not in place at the objective in five years is by recounting a news item the time of the experiment. In such situations, nil. Of course, they didn’t like which reported that on jurisprudence offers us a solution, and that is, the my comment. Nevertheless, I February 1, 2016, the UK Human judge should not add or subtract from what the recommended the approval Fertilization and Embryology law specifically provides. of the project because the Authority (HFEA) issued a In my own case, when we did the clinical studies technical know-how that will precedent-setting decision to on the hemodynamic pathophysiology of be generated by the project ALLOW Scientist Kathy Niakan hepato-splenic Schistosomiasis Japonica, the will find valuable application in from the Francis Crick Institute procedure we used in the experiment may not similar future research works. I in London to use the CRISPR– pass present day review. But then, at that time, was proved correct at the end Cas9, a powerful tool that no alternative was available. of five years. works like an editor for DNA, on viable human embryo only Likewise, in technical reviews, it should be Other specifics for providing a year after the same group sufficient for one or two authentic authorities a supportive and enhancing and ethicists expressed horror on the subject to pass judgement on the merit environment for researchers when the Chinese scientists did include:
5 Health Ripples Provision of the necessary tools, a supportive and conducive environment, and security for the scientist
1. Time protection for he gets from being a researcher. How I wish ladder. Unfortunately, this little researchers to tackle this at this time but there should be experiment was not sufficient another occasion to discuss this fully. The to radically change the past 2. Support from the institution scientist must also have academic security just and current practice in the for basic activities in the like the teacher. For example, his ascent in the University where a faculty laboratory like housekeeping, academic ladder, that is promotion to a higher member is still expected clerical works, and technical rank and tenure, must be based primarily on to teach, do research, help maintenance of the equipment his scientific output rather than performance in in administration, and get during the period in between non-related areas like teaching and academic involved in extension work. grants administration. My last story illustrates the bridge In conclusion, to empower 3. New paradigm in auditing connecting protecting the time and providing our scientists and researchers and financial rules security to the scientist/researcher. so that they will contribute to 4. Opportunities for continuing When I was chair of the Department of nation-building via scientific and regular interaction Medicine, I experimented on an arrangement productivity, an institution between and among to enhance the output of our researchers in the like the NIH should provide researchers department. I selected five faculty members the necessary policies and whose inclination was research. I instructed the practices that assure that the I will not elaborate on them. teaching monitors to free them from teaching scientists can do their work They are self-explanatory. The except when they expressly requested to be optimally. I have enumerated third and last of the primordial given lectures and preceptorships. I also freed three from my perspective. requirements is security in the them from administrative and extension service No doubt, the institution can scientific career. Certainly, this assignments. Furthermore, I instructed the identify others or may even is one of the most, if not the academic promotion board to consider only their prescribe a different priority. most, empowering practices scientific output when academic promotion and Whatever, the important for the researcher. By this, I tenure come up for review. message is do not expect a include material and academic jumbo jet to emerge from a security. Lo and behold! All five faculty members became junk shop. productive in terms of scientific publication The scientist must be able to while, at the same time, ascending the academic live decently with the income
The UP Manila Health and Life Magazine 6 Making significant, lasting IMPACT on PUBLIC HEALTH
Cynthia M. Villamor NIH’s researches are now becoming part of mainstream health care delivery not only in the highly urbanized areas but also in geographically isolated disadvantaged areas (GIDA). The reach of the technologies produced, the medicinal traits of selected plants and herbs, services available in NIH’s institutes and research centers, as well as the institutional changes brought by the policies created from its works, testify to how UP Manila has paved the way for its transformative role in nation building.
When then UP Manila environment not facilitative and supportive of With the signing into law Chancellor Perla Santos research as a major undertaking of faculty and of Republic Act 8503, Ocampo established the support personnel. the “Health Research and National Institutes of Health Development Act of 1998” The administration of Dr. Santos Ocampo and (NIH) on January 26, 1996, on February 13, 1998, the later, Dr. Alejandro de Leon (1996-2000), set the old, antiquated building of NIH was established as the the vision, goals and niche of NIH, that is to be the former Bureau of Science “coordinating and integrating the Philippines’ recognized authority in health became its home. That time, body of existing researches research and development and the key source research at the university was in UP Manila.” This act also of critical health information for national fragmented, uncoordinated, provided for public access development in the Philippines and Southeast and poorly funded. Worse, to research findings, facilities Asia. “Science for Humanity, Scientists with it had no collective vision, and other resources of the Souls” became the mantra to emphasize that with the other aspects of the different institutes. science should benefit the people.
The previous NIH directors, top to bottom, from left, Dr. Perla Santos Ocampo, Dr. Alejandro de Leon, Dr. Mario Festin, Dr. Jaime Galvez-Tan, Dr. Lulu Bravo, Dr. Vicente Belizario, Jr. and Dr. Generoso Abes.
7 Health Ripples Vice Chancellor for Research and NIH Executive Director Eva Cutiongco Dela Paz addresses health researchers during an anniversary celebration of the Institute in 2015.
The NIH’s first component was strengthened by ensuring protected time PNHRSand its allied agencies. units were the Institutes to do research, publish researches, train new Eventually, UP Manila was of Ophthalmology, researchers, and instituting a search program tasked as its lead convenor. Biotechnology and Molecular for nominees for scientific award giving bodies. The Research Grants Biology, Clinical Epidemiology, Administration Office (RGAO) The years that followed were periods of Pharmaceutical Sciences, was created to facilitate strengthening the organization under the and Socio-Biomedical financial support for capacity watch of Dr. Jaime Galvez-Tan (2002-2005) Research. The latter was the building. A new institute, and Dr. Lulu Bravo (2005-2011). The former’s NIH precursor, having been Institute of Herbal Medicine administration embarked on a campaign to established in 1988 as part was created. mobilize resources for research endeavors of the reorganization of UP through ingenious tie-ups with other agencies Through the leadership of Dr. Manila to ensure that the that firmed up the reward for research Vicente Belizario followed results of health research publications. The Office of the Deputy Director by Dr. Generoso Abes (2011- and development activities was created during his term during which time 2014), the functions of the are utilized to improve the the advocacy for the Philippine National Health various committees of the NIH people’s health. Research System (PNHRS) was started. were strengthened, among It also witnessed the early which were the University Dr. Bravo’s administration continued the system formative years of the Research Executive Committee, reenergizing with the institutionalization of Institute amid physical and Intellectual Property Office, ethics and inter-agency cooperation as the organizational constraints, RGAO, UP Manila Research cornerstones of research. As a result, research including the lack of support Ethics Board, Institutional was aligned with national health priorities and bodies and mechanisms to Biosafety Committee, UP oversight boards were set up, such as the expedite research. As years Manila Institutional Animal NIH Institutional Review Board, with ethics went by, additional institutes Care and Use Committee, and technical review committees that were were founded: the National and Resource Generation and recognized by the World Health Organization Telehealth Center, and the External Linkages. (WHO)-supported Strategic Initiative for Institutes of Child Health and Developing Capacity in Ethical Review and It was during this time that Human Development, Human Forum for Ethical Review Committees in Asia the NIH TCHREGCP was Genetics, and Health Policy and the Western Pacific Region (FERCAP). set up to respond to the and Development. capacity needs of the country Moreover, the NIH Training Center for Health Under the helm of Vice by providing trainings and Research Ethics and Good Clinical Practice Chancellor for Research courses that enhanced the (TCHREGCP) was established to support the Dr. Mario Festin from 2000- researchers’ expertise on the ethics and capacity building agenda of the 2002, the NIH faculty post various aspects of research
The UP Manila Health and Life Magazine 8 work. Close to 4,000 health researchers were trained at the end of 2014.
NIH Now
In 2017, after almost two decades of existence marked by the above milestones and significant developments, the NIH is considered a driving force behind many advances that have been contributing to the health NIRPROMP Project Head Dr. Nelia Cortes-Maramba receives a check representing royalty payment for the commercialization of lagundi and sambong as cures for common ailments of Filipinos. It continues to serve its mandate to be a Significant Contributions From research to products
major resource center for Through its 10 institutes, 3 centers, more Some of NIH’s milestone health research and capacity- than 40 study groups and a network of researches already translated building and to develop researchers specializing in varied health and into products include the outputs that serve as vital socio-biomedical fields, the NIH continues to herbal preparations for guideposts in shaping national generate technologies that guide and shape cough/colds and asthma programs and policies. national health policies and programs. (from lagundi), kidney stones (from sambong), abdominal Since its birth, the breadth Vice-Chancellor for Research and NIH Executive colic and spasm (from and scope of health research Director Eva Cutiongco-Dela Paz said that tsaang gubat), and body that the NIH envisioned is among the benefits of NIH researches were pain (from yerba buena). The being undertaken: “basic, their translation into products, national policies National Integrated Research applied, policy, product and and programs, and their serving as inputs Program on Medicinal Plants operation types, and the and basis for existing programs of the DOH, (NIMROMP) headed by Dr. application and utilization Department of Science and Technology, Nelia Maramba pioneered of its research findings and Department of Social Welfare and Development, the researches on medicinal conclusions.” This thrust and the Philippine Genome Center. remains consistent with the plants that started in 1976 and country’s vision of “Health for which included studies on the All.” above plants.
With existing and additional “UP Manila aims to further institutes, NIH continues to deepen its portfolio on enhance national efforts in natural/medical plant health care delivery through products (lagundi, sambong, research. Recent units tsaang gubat, etc) and build created were the Institutes on medical device/technology on Aging, Philippine National innovations, such as the EarInstitute, Newborn Dengue Diagnostic Kit, RxBox, Screening ReferenceCenter, and telemedicine,” stated and Newborn Hearing Chancellor Carmencita Padilla Screening Reference Center. during an open forum.Studies on the properties of the DOH- recommended 10 medicinal
Dr. Raul Destura demonstrates use of Biotek-M Dengue kit. plants are jointly conducted
9 Health Ripples hearing amplification devices with speech rehabilitation to promote optimum language development.
As of this time, over 100,000 have been saved from possible death, mental retardation, and other harmful health outcomes of genetic and metabolic disorders through newborn screening. In 2015, the expanded newborn screening program was implemented. Babies can now be tested for more than 20 disorders from by the NIH and DOH (please That the NIH is making headways in telehealth is the original six. see separate article). proven by the adoption of the RxBox and other The policy push on hearing devices nationwide. The RxBox: Integrating The Biotek-MTM Dengue aqua, screening and intervention is Medical Devices in the National Telehealth a faster and cheaper diagnostic driven by the 1.38 per 1,000 Service Program (NTSP) demonstrates the test for dengue with a higher Filipino children with bilateral integration of the National Telehealth Center’s specificity and sensitivity severe to profound hearing three major technologies under development developed by a team of NIH loss. Studies at the PGH – telemedicine and telemedicine device RxBox researchers led by Dr. Raul alone established the failed and the Community Health Information Tracking Destura,is now on a national roll- screening at 29% bilateral System (CHITS). To date, telemedicine has out (please see separate article). while very few babies were linked over 550 primary care physicians serving In the pipeline are diagnostic brought back for follow-up. At remote communities from Batanes to Tawi- kits for schistosomiasis, malaria, the Ear Institute, the average Tawi to medical specialists from the Philippine leptospirosis, filariais, and referral for diagnosis of hearing General Hospital (PGH), Eastern Visayas Regional chikungunya. loss was at three years of age Medical Center and Baguio General Hospital with only 30% referred at less Dr. Cutiongco Dela Paz and Medical Center. Telemedicine services than one year old. said that one of the most have covered health disciplines, such as surgery, anticipated projects is the Lab- orthopedics, pediatrics, ENT, internal medicine, A recent bill enacted in in-a-Mug that integrates and and maternal and child health. (please refer to early 2016 through the miniaturizes in an isothermal the UP Manila Health Ripples Issue on Telehealth, NIH researches on orphan unit as small as a muglife- July-December 2015) disorders was RA 10747, the saving diagnostics that are Rare Disease Act of 2016. vital for better management The law establishes and of illnesses leading to higher From research to policies integrates comprehensive survival rates and improved NIH has contributed three vital laws that were and sustainable medical care quality of life. Additional jobs products of long years of research. RA 9288, or and access for patients with are generated by the NIH the Newborn Screening Actof 2004 mandates rare diseases to the public researches through the dengue the screening of Filipino newborns for genetic health system. Another bill kit spin-off company, Manila and metabolic disorders and management to establish an integrated Health Tek and the increasing of confirmed cases. RA 9709, or the Universal utilization and promotion of commercialization of medicinal Newborn Hearing Screening and Early folic acid food fortification plants with a combined 48 Intervention Act stipulates the prevention, early and supplementation has licensees to date. screening, diagnosis and intervention using been filed in Congress.
The UP Manila Health and Life Magazine 10 methodology and design, ethics, scientific writing, and research management. NIH translates the knowledge that it generates from its researches into new knowledge, technologies, products, services, and policies. They are all disseminated in the various fora to create more opportunities for their acquisition.
National Telehealth Center’s Arturo Ongkeko leads attendees to an exhibit of the programs, services, The evolution of NIH depicts and technologies of the Center during its anniversary celebration. a model of how an academic center like the University From research to support for an estimated 480,000 Filipinos of which a of the Philippines Manila national health programs significant cases are preventable and treatable. reconfigures into an academic NIH has conducted national For recognizing the need to screen children system. Frenk, Chen, Bhutta, surveys in support of DOH for vision problems and developing a Vision et al. (2010) explained that programs, such as the National Screening Kit as a tool to prevent blindness such transitioning “extends Surveys on Blindness and through early detection and treatment, the the traditional discovery – Visual Disability, Intestinal NVSPKP was conferred the 2017 Alberto G. career education continuum Helminth Infections in Pre- Romualdez, Jr. Outstanding Health Research in schools and hospitals into school or School-age Children Award in the Health Services Research Category. primary care settings and in the Philippines, National Oral Currently being legislated is a National Vision communities, strengthened Health Survey, Mental Health Screening Act that stipulates mandatory through external collaboration information Systems, Sin Tax screening of kindergarten pupils and two bills as part of more responsive Law, and Philippine Health on the National Telehealth Act which were and dynamic professional Insurance. Such surveys drafted and being finalized through data education systems.” provided baseline data that generated by NIH studies. The fruits of NIH’s labor are served as inputs for policy now becoming part of the formulation, program planning, The NIH’s pioneering research and advocacy mainstream health care and projections in the case of work on telehealth led to the inclusion of system delivery not only in sin tax and health insurance. eHealth in the DOH’s National Objectives for Health and the National Unified Health the highly urbanized areas For eye diseases, two major Research Agenda for 2010-2016. They also but also in geographically screening programs, the paved the way for the creation of the National isolated developing areas. National Vision Screening eHealth Steering Committee to oversee the The reach of the technologies Program for Kindergarten alignment of all eHealth-related initiatives and produced like the RxBox and Pupils (NVSPKP) and the projects in the country. CHITs, the medicinal and screening of premature therapeutic traits of selected babies for Retinopathy of plants and herbs, services Prematurity aim to save Contributor to nation building available in NIH’s institutes and Filipino children from research centers, as well as the As the Training Center for Health Research permanent blindness. institutional changes brought Ethics and Good Clinical Practice, the NIH Blindness from ROP and by the policies created from provides training and courses that enhance amblyopia are part of the its works, testify to how UP researchers’ capacity for research, including causes of blindness of Manila’s leadership has paved
11 Health Ripples the way for the transformative role of the university in nation building. The partnership that the university has built with local, regional, national, and international organizations form a responsive culture of inquiry that ensures sustainability of the generation of knowledge, technology, services, and policies for the 21st century.
New NIH building
By 2019, a modern 18-story NIH building will rise on a 4,000 sq meter lot with state- of-the art facilities and cutting- edge laboratories. There will be venues for collaboration with health industry partners and agencies, meeting and conference rooms, theater and audiovisual rooms, and Institutes and Centers: learning nooks that will allow • Institute of Aging | Director: Shelley Ann F. Dela Vega, MD, Msc for greater interaction among (02) 526.4349 • http://nih.upm.edu.ph/institute/institute-aging researchers. • Institute of Molecular Biology and Biotechnology | Director: Dr. Edsel Maurice Salvana (02) 450.1962 • http://nih.upm.edu.ph/institute/institute-molecular-biology-and-biotechnology It will have a future National • Institute of Clinical Epidemiology | Director: Marissa M. Alejandria, MD, MSc, FPCP, FPSMID Center for Biosafety and (02) 525.4098 • http://nih.upm.edu.ph/institute/institute-clinical-epidemiology Biosecurity, Clinical Research • Institute of Pharmaceutical Sciences | Director: Erna C. Arollado, PhD Center, and Animal Research (02) 577.2001 • http://nih.upm.edu.ph/institute/institute-pharmaceutical-sciences Facility. With streamlined • Institute of Human Genetics | Director: Dr. Mary Anne Chiong operations, a strong ethics (02) 526.1725 • http://nih.upm.edu.ph/institute/institute-human-genetics and expanded grants • Institute of Child Health and Human Development | Director: Anna Lena Lopez, MD, MPH administration, and an (02) 524.0892 • http://nih.upm.edu.ph/institute/institute-child-health-and-human-development-0 upcoming new building, the • Institute of Health Policy and Development Studies | Director: Hilton Y. Lam, PhD, MHA NIH is poised to expand and (02) 526.4349 • http://nih.upm.edu.ph/institute/institute-health-policy-and-development-studies strengthen collaborations • Philippine National Ear Institute | Director: Charlotte M. Chiong, MD, PhD nationally and internationally (02) 554.8400 loc. 2072 • http://nih.upm.edu.ph/institute/philippine-national-ear-institute to build sustainable solutions • Institute of Herbal Medicine | Director: Cecilia Maramba-Lazarte, MD, MScID, MScCT for the country’s and the (02) 526.4384 • http://nih.upm.edu.ph/institute/institute-herbal-medicine Filipinos’ optimal health. • National Telehealth Center | Director: Dr. Raymond Francis Sarmiento (02) 509.1003 • https://telehealth.ph Reference: Frenk J, Chen L, et al. Health • Newborn Hearing Screening Reference Center professionals for a new century: transforming education to strengthen (02) 554.8400 loc. 2153 • newbornhearingscreening.ph health systems in an interdependent world. Published online at www.thelancet. • Newborn Screening Reference Center | OIC: Riza Suarez com (DOI:10.1016/S0140- 6736(10)61854- (02) 522.4396 • https://www.newbornscreening.ph/ 5) on Nov 29, and in The Lancet Dec 4, 2010, vol 376; pp 1923–58). • Philippine Eye Research Institute | Director: Leo DP. Cubillan, MD, MPH (02) 524.7119 • http://nih.upm.edu.ph/institute/philippine-eye-research-institute
The UP Manila Health and Life Magazine 12 Seeing the need for a more accessible and accurate option, Destura, as lead scientist, developed a dengue-diagnostic kit that harnesses the power of molecular-based technology minus the significant expense attached to it. Hence, the creation of Biotek-MTM Dengue aqua – a commercialized, locally-developed technology that detects the presence of the fatal infection in the first 0 to 5 days of illness. 1st Dengue Diagnostic Kit by UP Manila Scientists - FASTER, CHEAPER, and PROUDLY PINOY
Anne Marie D. Alto
Ms. Joy Ann Santos, Dr. Raul Destura, and Ms. Kristine Marie Flores-Destura with the Biotek-MTM Dengue aqua kit
Resolving the smallest to Just ask Dr. Raul V. Destura – he and his team nationwide in the first half the grievous of the country’s did just that. of 2017, most of those cases problems requires collective belonged to children age 5 action from people who believe to 9 years old (Department of strongly that their common Biotek-MTM Dengue aqua Kit Health, 2017). aspirations can transcend Dengue, a mosquito-borne disease, becomes While the casualties mount, all kinds of barriers. This most dangerous when not treated early; and the burden of combating includes our scientists whose one of the main reasons why it costs lives is the disease is carried mostly role is to take research a step prolonged detection of the virus. Data from by those in the marginalized further and explore uncharted the Dengue Disease Surveillance Report sector who will have to shell territories rather than just of the Department of Health show that a out P4,000 to P7,000 to putting them on paper. total of 58,598 dengue cases were reported take the Polymerase Chain
13 Health Ripples Reaction (PCR) – the popular (ribonucleic acid) products with a simple inside the improvised heating dengue detection method heating device. It’s simpler, easier, and cheaper tube made of PVC pipe, and are – or the NS1 Antigen that than the standard molecular test the world heated at the right temperature costs about P1,000 to P3,000. enjoys,” he said. (63°C) until the thermometer Yet these numbers are just indicates that the samples are While NS1 Antigen and the PCR are the the cost per test, it will still ready. commonly used dengue-diagnostic tests in depend on how many tests the country, both have their pros and cons in In less than an hour, the vials are deemed necessary to detection and accessibility. will be transferred from the confirm if the symptoms heating device to the LED one suffers from are those of “NS1 picks up the disease in the first 0 to 5 days transilluminator. Against the dengue fever or not. of illness. Unfortunately, the results of the test
(1) Nucleic acid extracted from the blood and transferred to a small vial. (2) Vials placed inside the improvised heating tube made of PVC pipe. (3) Samples heated at 63°C.
Seeing the need for a more are affected by the immunological status of the blue light, the samples will accessible and accurate patient. Kung kailan nagiging secondary dengue change into green if the blood option, Destura, as lead – ito ‘yung mas severe na ang manifestation – is positive for dengue or will scientist, developed a doon bumabagsak ang sensitivity pa lalo ng NS1 maintain its orange color if it is dengue-diagnostic kit that to as low as 40%. clear of the fatal disease. harnesses the power of This means that the technology fails at that Through Biotek-MTM, doctors molecular-based technology point when you need it the most. A molecular would make better decisions minus the significant expense test like PCR similarly can pick it up. And it’s for their patients if they can attached to it. Hence, the really good! Sensitivity can go as high as 95%. confirm or rule out dengue creation of Biotek-MTM Dengue Unfortunately, a powerful technology, but a the soonest possible time. aqua – a commercialized, very few can access them,” Destura notes. Moreover, institutional units or locally-developed technology hospitals would not have to that detects the presence of The Biotek-MTM costs only a third of the PCR test admit every patient suspected the fatal infection in the first 0 and half of the NS1 amounting to P700 to P1,500 of dengue. This would to 5 days of illness. per test. In addition, the kit is designed and translate to better delivery of operated in a very simple way. First, the nucleic “Biotek-MTM is a molecular healthcare to the patients – acid is extracted from the blood and transferred test that amplifies RNA the hospital would have fewer to small vials. The vials are then placed securely
The UP Manila Health and Life Magazine 14 Dengue-positive sample turned green against the custom-designed LED Transilluminator.
admissions, the staff will have schistosomiasis, leptospirosis, more time to attend to other Having a shared goal of Zika, and paragonimiasis, patients, and there will be which already have their proof more available resources to identifying a common of concepts and will set off patients who need them the and deadly virus at its once funding is secured. most. early stage, Destura and The grant enabled the team Think of it this way: Biotek- to conduct the study which MTM crosses three hurdles his team have untangled a they completed in almost with one leap. It is accurate, two years from 2010 to 2012. time-saving, and low-cost new method of detection Having a shared goal of Filipino-made technology that is within reach of the identifying a common and that provides access to the deadly virus at its early stage, marginalized sectors. Filipino people, unlike the Destura and his team have previous inventions. untangled a new method of detection that is within reach Lab-in-a-Mug Project: of the Filipino people, unlike The Search for Grants The grant was implemented by the the previous inventions. National Institutes of Molecular Biology and In 2010, Destura and “First we identified a need Biotechnology under the name Lab-in-a-Mug seven other co-inventors for technology, then we project. composed of infectious discussed what the best diseases specialists, According to Destura, all diagnostic kits in platform technology is for this molecular biologists, and this project are integrated and miniaturized particular problem, and then biotechnologists received in an isothermal unit as small as a “mug” we arrived with technology a grant given to the that will function as a multi-infectious using isothermal amplification. Philippine Genome Center disease diagnostic device similar to a After deciding what platform by the Department of portable laboratory. The “Lab-in-a-Mug” to use, the experimental Science and Technology’s was also conceptualized, designed, and methods were done for proof Technology Innovation for piloted at the Institute of Molecular Biology of concept. After finding Commercialization and and Biotechnology, National Institutes of the proof of concept that Technology Application and Health, University of the Philippines Manila it is feasible, the laboratory Promotion Institute, and the with Destura as project leader. In the performance testing assay on Philippine Council for Health pipeline are testing kits for tuberculosis, known standards and controls Research and Development. salmonella, chikungunya, influenza, malaria, followed. When it passed
15 Health Ripples laboratory performance assay, In 2013, Destura and his team formed the technology was transferred to we Identified the analytical Manila HealthTek Inc. to commercialize Biotek- Manila HealthTek Inc. sensitivity and specificity MTM Dengue aqua kit and the rest of the Lab- “It needed a lot of based on laboratory in-a-Mug projects. “It’s easier now that it’s a capitalization. But it has performance. After getting spin-off company. All of the kits arrive much entered the mainstream the number, we proceeded earlier and the performance is way better than market which is the with clinical validation study the ones you tested in clinical trials. The clinical Department of Health. We to test it with actual patients trial performance was already adequate for are going into sectional needing it,” Destura explained. clinical use, the added performance power discussions with the local was a pleasant surprise to us.” Completing the sample size government units and private was a major challenge to The Manila HealthTek Office stands in hospitals to take in the test the effectivity of the kit. Marikina where the kits are currently being technology,” Destura added. The first trial required over mass-produced. But since the team initially The Manila HealthTek is 100 patients and the second developed the kit as part of a research and not limited to Biotek-MTM. consisted of more than development program funded by several It is also dedicated to 500 patients. Getting the organizations, they had to secure their developing, manufacturing, consent of that magnitude of approval, apply for a license, and comply and distributing technology patients was another issue, with regulatory processes before formally for diagnostic medicine. They considering that not everyone commercializing the kit. promise quality and accurate wants to be part of the study. diagnosis of communicable The team got most of their and non-communicable patients from the National diseases at a fraction of a Children’s Hospital, Philippine cost. General Hospital, and the Medical City. Its Research and Development Division and “We filed for Food and Molecular Diagnostic Services Drug Authority (FDA) Division help provide the approval and it is now an necessary support to local FDA-exempt technology, and international scientists manufacturing site-approved, from designing the laboratory and commercial laboratory- component of their research approved.” proposal to expanding their market reach.
Braving the Destura admits that credit for Mainstream Market Biotek-MTM should not entirely go to him but his team of Many factors contributed to the inventors. “They gave more delay in using the kit; the supply than I expected them to do in chain being one of the major terms of commitment [and] roadblocks. “The procurement that meant a lot. I made them process and the arrival of the co-owners of the company reagents are a huge challenge The Biotek-MTM LAMP Heater Device Manila HealthTek Inc., this is while we’re doing the clinical also to send a message to trial. Some kits arrived on time, For three years, the company had to diversify other technology developers some are near expiring. When its services to sustain their income while not to leave their associate you put them all together, it waiting for the rights to be granted. Finally researchers behind.” really affects the integrity of in 2016, the rights to commercialize the your kits.”
The UP Manila Health and Life Magazine 16 The Manila HealthTek Inc. office in Marikina City
From Laboratory to “We became the second-line testing for for the country, then you Business to Policy: Dengue. If NS1 turns out to be negative in its just have to bite the bullet A Translational Research result, it will be re-tested using the Biotek-MTM,” and stop making excuses for Destura said. things that you cannot do Aside from problems because the only thing that concerning design, laboratory stands in the way is you.” performance assay, clinical Looking Ahead validation, and marketing Every individual has a critical analysis, there’s also the issue Destura and the team are looking even further role in working on something of scrounging for funds. down the road for innovations even if the kit great for this country. These Indeed, it has taken years is still on the roll-out. He said that the drive scientists are willing to play for Biotek-MTM to fly off the to create innovations in healthcare delivery is their part in technology ground but when it did, it fueled by one simple thing: love for country. development, powerful achieved noteworthy success. enough to bring acceptable, “Biotek-MTM is not about me. Biotek-MTM is for accurate, and affordable The Department of Health this country. That has been our inspiration in healthcare within reach of the recognized this major developing this technology. I certainly have Filipinos. advancement in dengue grown so much from the experiences that the detection and made it into entire team has gone through. Things happen Reference: a policy to be the second for a reason and it happens at the right time, Department of Health. (n.d.). Retrieved from www.doh.gov.ph: http://www.doh. confirmatory method of the given the right moment. If you are clear with gov.ph/sites/default/files/statistics/2017_ Dengue Diagnostic Program. your vision, what you want for yourself and Dengue_MW1-31.pdf
The Biotek-MTM Dengue aqua inventors. Left to right: Sharie Keanne C. Ganchua, Joy Ann Petronio-Santos, Dr. Carmencita D. Padilla, Kristine Marie Flores-Destura, Dr. Raul V. Destura, and Dr. Jesus Emmanuel A.D. Sevilleja. Not in photo are Ricky B. Vinarao and Romel R. Gomez.
17 Health Ripples No Cold Feet: A Filipino Scientist’s Journey He dreams “for the Philippines to become the next biotechnology hub of Asia and for the Filipino scientists to be recognized as biotechnology developers that improve human health not just in the country but in the world.” January R. Kanindot
Blessing in Disguise Until one day, he received a phone call from his brother. It was 2003, two years after He asked Raul if he and his 9/11 - an attack on American wife had a fight because soil occurred that left one when he asked her how she of the world’s superpowers was, she broke down and vulnerable. In its wake, revealed that they were the US modified some about to lose their home. of its policies. Dr. Raul V. This hit him hard like the Destura, Raul as he is fondly world came crashing down called, had no idea of the on him, all the while he magnanimity of the changes thought he was protecting of this terror attack on him. her but in fact, she was He was an enthusiastic protecting him. He had been scientist on his first trip to enduring everything for four the US. He was accepted to long months because he felt the International Training that his pursuits were worth and Research in Emerging it, he could have endured Infectious Diseases (ITREID) more but sacrificing his Research Fellowship Dr. Raul V. Destura family’s safety and security Awarding the University of was not part of the deal. He Virginia (UVA). knew then what he had to He could have endured do. He was going home. But, alas, upon his arrival, due to the change in more but sacrificing Walking to his apartment policies, he was unable to in the freezing weather, he secure a Social Security his family’s safety thought, perhaps this was Number (SSN). In the US, and security was not God’s way of telling him without an SSN, it basically to stop. Maybe something meant you are paralyzed. part of the deal. else was in store for him. Raul was unable to access He was a little numb and the money from his hardly bare-minimum. Every day, he walked he was sliding all over the scholarship and receive pay to the University as he could not afford fare. place because he was for his work. He was forced He told his wife that he had free food but to wearing leather shoes, and to live in a government- stave off hunger, he lived on a gallon of milk in that frigid and desolate subsidized apartment that for breakfast, lunch, and dinner that cost moment where his body was was basically a shelter for him USD1.99. It was winter, he had to make enveloped in cold and his the homeless. The only do with layering his clothes as he could not heart was sinking over an support he got was an afford to buy anything. It was a humbling impending inevitability came allowance of Php10,000.00 experience for an established doctor but a woman’s voice. He was his wife sent him monthly. it was a dream he wanted to pursue so he momentarily yanked out of He was stripped of everyday kept moving forward despite all the daily his solitary bleakness. An luxury and forced to live on struggles.
The UP Manila Health and Life Magazine 18 Dr. Destura enjoying the company of his colleagues.
Asian looking lady was right never intimidated by the unknown. It was in front of him. She must a constant nagging feeling in his head, He was never have noticed something was of what ifs and what is. This particular amiss. She offered him a curiosity has led him to take Microbiology intimidated by ride back to his apartment. at the University of Sto. Tomas. The facets the unknown. It Later that day, the lady told of microbiology cemented his dream Raul’s plight to her group of becoming a scientist in molecular was a constant of Filipino friends, and he microbiology. However, his father suggested was invited to one of her to take medicine, insisting that he will nagging feeling friend’s home and he was appreciate molecular science more if he introduced to other Filipinos became a doctor. His father was his role in his head, of who later on helped him model, and as Raul puts it “it was for this what ifs and arrange his paper works. weird paternal hypnotic reason” that he And the rest is history. agreed. what is. Had it not been for that providential encounter, Raul To his dismay, medical school was a would have gone home complete torture! He basically felt like and Community Service by resigned to a different life. lectures were a major cause of coma. He forging strong collaboration Today, the Asian looking was impatient, uninspired and sadly full of among these disciplines lady named Thessa and excuses. He studied not out of love but out to reach a focused goal. another Filipina, Daisy who of fear of being kicked out. Years later, as it My research bench to took him in to her home, turned out, all hope was not lost because community approach became Raul’s second family when he started his clinical clerkship, things is ultimately geared in Virginia. Over the years, began to change. His patients broke through towards developing low- they have witnessed one his catatonic perceptions. He began to see cost technologies for another’s successes and his mission. He began to see his impact. His the control of infectious sorrows. desire to change the health outcomes of diseases in the Philippines impoverished people began. and the generation of new knowledge to find Having a Dream and Now, Raul has come a long way from being sustainable and equitable Starting Somewhere the detached boy. He has transformed solutions to diseases of himself into a man of purpose. Today, his poverty.” Growing up, Raul was a drive is stronger than ever. He relates that curious child. He was always “as a clinician–scientist, I continuously try Perhaps Raul was destined excited about what is out to narrow down the gap among the Basic to a rollercoaster life as there in the world. He was Sciences, Medical Sciences, Biotechnology he has been met with setback after setback but
19 Health Ripples he has managed to turn Philippines Manila - National Institutes generated by himself and things around. His arduous of Health as a research faculty. In 2008, his research faculties. Proof experience in UVA has made he became the Director of the National that blank piece of paper him realize how lucky he Institutes of Molecular Biology and can go a very long way was to be chosen, to be Biotechnology of UP-NIH. The directorship with the right dedication, in the presence of select gave him so much excitement. It sounded determination and fellows from different so glamorous! He was finally given a job persistence. countries (China, Ethiopia, where he had the authority and venue Brazil, Japan, and US). He to put his skills and training to good use. To further his dreams, Raul vividly remembers their But in keeping with the rollercoaster ride proudly transferred the first laboratory meeting, of Raul’s life, he was met with an empty wheel of the institute to his colleagues were talking office, a disconnected phone-line, a busted another brilliant returning about apoptopic pathways, air conditioning system and PhP 2,377.30 Filipino scientist as he cell-signalling mechanisms, budget! It was disheartening to say the least. pursues in bringing his migration and proliferation research outputs all the of epithelial tissues, He allowed himself to savour and bask in way to the marginalized genotyping, ribotyping. He self-pity but only for about 30 minutes. He sector by creating the first just quietly nodded at them then had a Eureka moment. What can he university biotechnology pretending to understand do with 2,377.30 pesos? Well of course, he spin-off company of the the discussion but he was could buy bond papers for his upcoming University of the Philippines, feverishly typing every task of writing proposals. Tons of proposals the Manila HeathTek Inc. word that came out of their to every funding agency he could think of. Its current flagship product mouths. He was in fact, as He had his office phone reinstalled so he is the Biotek-MTM Dengue we put it in local street slang, could sell his “larger than life” institute to aqua kit. (Please see related “nosebleeding.” A believer his colleagues abroad. Php2, 3770.30 bond article). The kit is a more in independent learning, he papers later, he got his first break for a small affordable and equally spent the first three months proof of concept grant that started the ball reliable diagnostic tool in the university library rolling and the rest, yet again, is history. for one of the country’s reading and learning. health threats. When he Today, the institute has seven research and his team developed It finally dawned on him, faculties, three are returning scientists, 17 the kit, the intention was to that his father was right, research staff, over 100 mentored students, bring it to the marginalized being a physician helped 10 visiting scientists, over 50 scientific sector because the cost him ask the right health- papers, book chapters, abstracts and associated with molecular related questions and modules, 7 patent applications, and houses based technology was only write appropriate research one of the most advanced molecular facility accessible to the more laboratory design. He ended in the country. It has over PhP300,000,000 affluent. Also, with the up becoming a scientist- (USD ~ 6M) research grants so far. All current set up of research collaborator in a Biodefense program in UVA. He could have stayed in the US but all the access to first world technology made him realize that his life’s meaning and purpose is back home where there were more than enough third world health problems that needed to be solved. In 2005, he decided to return home, this time around, for the right reasons.
That same year, he joined the University of the
A younger Dr. Destura with his colleagues from the University of Virginia.
The UP Manila Health and Life Magazine 20 in the Philippines where time management skills and red tape and check and From being a researcher, learn to say no to certain balance sometimes prevent circumstances. In his free a research project to take he also became an time he likes to spend it off, he had to do something entrepreneur. He believes with his wife, Ning and two to make his kit a reality. He kids Niko and Miggy. He ended up taking Masters in that this is a good path for concedes that while he has Business administration at sacrificed so much in the the Ateneo de Manila School researchers in this country. pursuit of knowledge, his of Business. From being a sacrifice pales in comparison researcher, he also became To have the knowledge to the daily sacrifices of his an entrepreneur. He believes and skills to transform wife to support him in all his that this is a good path for endeavors. He is grateful researchers in this country. To a research work into an that she has stood by him in have the knowledge and skills all the rollercoaster rides of to transform a research work actual product that his life. To remain sane, Raul, into an actual product that the likes to destress himself by Filipino people can actually the Filipino people singing and painting. use. Biotek-MTM is now in full swing production. He hopes can actually use. His Life’s Legacy that it will be available in more hospitals soon. paper, prepare things and, at the end of This soft spoken man could the day, the information generated may go on and on talking about not be satisfactory. And a researcher must his passions in animated Time is of the Essence finish his work because other researchers and earnest candor. His in countries with better resources may be positivity is infectious that For him, a researcher’s doing the same and beat him to his game. no matter how serious the greatest commodity is time. That being said, Raul is not all work and no topic, he never forgets to Time to finish work, to do play. He admits that he needs to improve his smile. There is no doubt experimentation, write the that his joyful and persistent
Dr. Destura jams with UP President Alfredo Pascual during a testimonial tendered by UP Manila.
21 Health Ripples demeanor has carried him through all the frightful challenges he has had in his life. In his presence, he has a certain way of making you feel at ease and his humility is pervading that you forget that you are talking to a very accomplished scientist: The Medical City Physician Innovator in 2006; Outstanding Young Scientist of the Philippines in 2008; UP’s Research Productivity Awardee in 2011; one of the Top 20 Young Physician Leaders of the World in 2011 given by the Inter- academy Medical Panel in Berlin, Germany; and The Ten Outstanding Young Men (TOYM) of the Philippines Dr. Destura with his wife, Ning, and sons Niko and Miggy. in 2011. In 2015 he received Distinguished Researcher Awardee. He to become the next 2 national awards and believes that receiving an award is not just biotechnology hub of Asia; 2 recognitions from the to boost once ego but to be a source of for the Filipino scientists universities he studied inspiration of one’s life work. to be recognized as from namely, the Dr. Jose P. biotechnology developers Rizal, National Awardee in He is not only respected but is also well that improve human health Research, from Philippine loved by his colleagues, staff and mentees. not just in the country but Medical Association and His generosity is reputable. While he admits the world. That for those Dr. Eusebio Y. Garcia that research is financially challenging, he who will follow this path, Awardee in Molecular would be the first to shell out his personal I am so excited to know Biology and Molecular money for the love of science. Co-inventor and to learn that they will Pathology, National Research of the Biotek-MTM Dengue aqua kit, Joy surpass all the things that I Council of the Philippines; Petronio shares that “He is a mentor that have done. So, in the end, the Outstanding Alumni knows his craft but will allow you to do your when you talk about legacy in Medical Sciences, thing. I mean, he will not impose his ideas is when I am walking around De La Salle University, but will encourage you to think also. He is the streets somewhere or in Manila Philippines; the open to suggestions and/or comments. He a health care center, seeing Outstanding Alumni in knows how to appreciate people working the technology helping Medical Microbiology, for him and with him. He is not selfish and marginalized individualsor University of Sto. Tomas, will support your endeavor even if it means all persons using your Manila Philippines. In 2016, leaving the institute for greener pasture. technology because they his Biotek-MTM Dengue kit It is not difficult to ask help from him. can afford it. Then that was given Gregorio Zara Sometimes, he tends to say yes to almost completes the story of me Outstanding Technology everyone that tend to use up all his time. He being a scientist.” Commercialization Award was the one who inspired me to do great in by the National Academy what I love to do. He would tell us (especially This envisioned legacy of Science and Technology during my first few years at NIMBB) that our is captured in what Raul and recently, his peers from research is nothing if it will not translate wrote in the glass wall at the medical community into something that will benefit the people, the second floor of the recognized him as the especially the less privileged ones.” Manila HealthTek office: 2017 Philippine College He relates that if he could have it, his “Everything that starts here of Physicians Exemplar greatest legacy would be ”for the Philippines is for the country.”
The UP Manila Health and Life Magazine 22 “There will be a time when one’s mind cannot formulate new synthetic medicine, but God is always there and His creation and the active principles created by God will be the ones to save mankind.” - Dr. Nelia Cortes-Maramba
The researchers and staff of the Institute of Herbal Medicine, with other participants at the first Herbal Medicine Summit. Herbal Medicine: FINDING its NICHE in PHILIPPINE HEALTH Charmaine A. Lingdas
Once accorded lukewarm dedication, and competence in their NIRPROMP as pioneer of response due to the researches fuelled in others after them the medicinal plant research overwhelming acceptance of desire to continue what they had started in the Founded in 1974, with Dr. modern medicine, the field hope of providing cheaper, safe, and effective Conrado Dayrit, Professor and of herbal medicine in the cures for common ailments. former Chair of Pharmacology Philippines today is finding its Long before research on herbal medicine at the University of the rightful place in the medical was institutionalized at UP Manila through the Philippines College of and scientific community. creation of the Institute of Herbal Medicine Medicine (UPCM) as Program This is largely attributed to under the National Institutes of Health, the Coordinator, and Principal the seeds sown by the early National Integrated Research Program on Clinical Investigator Dr. believers and pioneers of Medicinal Plants (NIRPROMP) had been Nelia P. Cortes-Maramba, medicinal plants whose story undertaking researches on several medicinal NIRPROMP was established of hard work, perseverance, plants for over 30 years. with the encouragement and
23 Health Ripples guidance of Dr. Florentino research proposal, a doctor came to her From NIRPROMP to IHM Herrera Jr., together with and mockingly placed a white handkerchief On March 29, 2007, the Board other researchers, namely on her head, imitating a fictional character, of Regents established the Dr. Natividad F. de Castro, “Mang Kepweng.” Mang Kepweng, who had Institute of Herbal Medicine Dr. Horacio R. Estrada, mysterious healing powers, was popularized in (IHM) as a component National Scientist Clara Y. the 1970s representing the traditional Filipino institute of NIH. NIRPROMP Lim-Sylianco, Prof. Ernesta folk healers or albularyos. Undeterred, Dr. was integrated into the IHM G. Quintana, Dr. Romeo Maramba responded, "I am proud to be Mang as one of the study groups F. Quijano, Dr. Cecilia Kepweng." and is still headed by Dr. Vargas Zamora, and Jerry “Back then, they didn’t understand that the real Nelia Maramba. NIRPROMP's D. Saludez. NIRPROMP motive behind it is to have low-cost medicine,” numerous successes after created an integrated multi- she explained. more than three decades are disciplinary team dedicated now being built upon by the to investigating the potential NIRPROMP’s mandate is to develop IHM in fulfilling its mandate. use and benefits of herbal inexpensive herbal medicines for the poor, medicines. propagate the use of herbal preparations Today, the IHM is recognized with proven medicinal safety and efficacy as a leading institute in “In the beginning, there was and identify scientifically validated medicines facilitating research dedicated not much acceptance by the that would provide products for the Filipino to herbal medicine in the medical community of herbal pharmaceutical industry. It aimed to address country. Its multidisciplinary medicines," narrated Institute of the rising costs of imported pharmaceutical team is composed of experts Herbal Medicine (IHM) Director products and prioritize the reduction of the in the field of agriculture, Dr. Cecilia Maramba-Lazarte. country’s dependence on imports and offering chemistry, pharmacology, and Dr. Maramba-Lazarte of more affordable pharmaceutical products medicine. Its agricultural unit recounted that “back then through locally developed herbal medicines. provides raw materials for the some doctors questioned preclinical and clinical trials From 1977 to 1982, NIRPROMP’s work started the need to study herbal and research on the proper by surveying more than 1700 herbolaryos products when there were so propagation and cultivation of
The mother and daughter team of Dr. Nelia Cortes-Maramba and Dr. Cecilia Maramba-Lazarte, champions of medicinal plants. many drugs available in the medicinal plants. Its chemistry (herbalist folk healers) on plants used for market.” A daughter of Dr. unit is responsible for specific indications and any side effects Nelia Maramba, also known mutagenicity/clastogenicity caused. Out of the 1,500 plants identified, as the "Mother of Philippine studies and isolation of NIRPROMP scientifically validated that 480 Herbal Medicine," Dr. Lazarte active compounds. The of them contained beneficial medicinal recalled that in one of the pharmacy unit is focused on properties. presentations of her mother’s plant material processing,
The UP Manila Health and Life Magazine 24 Dr. Nelia Cortes-Maramba (seated, center) with former UPM Chancellor Manuel Agulto and a Pascual Laboratories representative, with other NIRPROMP members, during the signing of the agreement for lagundi and sambong.
formulation, and quality to document the traditional control. The field of basic IHM aims to undertake healing knowledge of and clinical pharmacology is different herbolaryos among responsible for the pre-clinical scientific, ethical, and the indigenous peoples and and phase 1, 2, and 3 clinical other cultural communities trials. culturally sensitive research in the country and to protect indigenous peoples’ claim to “The objective of IHM is to in an integrated and their cultural heritage, IHM undertake scientific, ethical, developed the Philippine and culturally sensitive multidisciplinary approach Traditional Knowledge Digital research in an integrated and Library on Health (TKDL- multidisciplinary approach to to produce safe, efficacious, Health). The project is headed produce safe, efficacious, and by former IHM Director Dr. more importantly low-cost and more importantly Isidro C. Sia. To date, there herbal medicines." low-cost herbal medicines. is information on 13,900 medicinal plants from all over the country. Back to Folkloric Herbal ethnographic study before proceeding to the Medicine actual research,” she stated while explaining The Department of Health the indications on determining what plants (DOH) Philippine Institute of Why focus on herbal are effective, a kind of study calledReverse Traditional and Alternative medicines? Maramba-Lazarte Pharmacology. Health Care (PITAHC) and the stated that a lot of our Department of Science and modern-day products came When the NIRPROMP research team realized Technology (DOST) Philippine from various plant sources. that over 500 projects were done before Council for Health Research Research in herbal medicines, which were related to isolating active and Development (PCHRD) according to her, usually ingredients in plants but none of which had are the two funding sources takes 5 to 6 years compared been successfully commercialized, they found for the research of the IHM. to the study of conventional out that one of the reasons was consumer “PCHRD and PITAHC provides synthetic medicines that distrust on unknown plant sources. However, funds for herbal medicine usually takes 10 to 15 years. many consumers trust herbolaryos and research and work together to subsequently, the research team shifted “You have to go back to the avoid duplication of research to collecting folkloric data and conducting herbolaryos (herbalist folk projects.” scientific tests to validate the herbolaryos’ healers), to the traditional claims. “The NIH Institute of Herbal medicine healers and do an Medicine is one of the many With the efforts of the researchers of the IHM
25 Health Ripples institutions that are active in herbal medicine research in the country. As a national university, our mandate is not only focused on UP Manila but for all institutions and universities in terms of research and development,” Sia emphasized. Some of the commercial brands of lagundi and sambong Sia discussed that there are institutions and universities identified by PCHRD as Tuklas the additional research reports of Dr. Fabian lagundi cough medicine syrup Lunas Centers, which are M. Dayrit on the active principles of lagundi formula to UP Manila, which provided enough funding and leaves. In 1994, researchers successfully was then tasked with further is hoped to imitate what IHM developed a lagundi-based cough medicine research and development has achieved in doing herbal in tablet form and in 1999, researchers (R & D) work, licensing, and medical research. “UP Manila successfully modified the formulation of commercialization activities. lagundi cough tablets into a lagundi cough NIH-IHM is not included as When lagundi cough medicine syrup. Tuklas Lunas Center, because was first launched in the IHM is the forefather of Tuklas Lagundi or five-leaf chaste tree is an herbal market in 1994, it faced an Lunas Centers, through the medicine used for the relief of nonbacterial uphill battle of consumer NIRPROMP,” he asserted. cough due to the common cold, flu and mild skepticism. However, through Sia affirmed that one of to moderate acute bronchitis and for or relief concerted efforts to improve NIRPROMP’s achievement of reversible mild to moderate bronchospasm the image of herbal medicines, was its research in the ten with obstructive airway disease, such as asthma the drug has been a success medicinal plants that is and chronic bronchitis. Available formulation for many companies. At endorsed by the Department includes 300mg/tablet and 600mg/tablet present, lagundi is licensed of Health. These plants, Sia for adults, and 300mg/5mL syrup and to 18 companies of which 13 emphasized are “lagundi 600mg/5mL syrup for children. are already in the market, with one company’s Certificate of for cough, sambong for "The clinical trials of lagundi showed that Product Registration (CPR) just kidney stone, tsaang gubat that the medicine decreased the frequency approved, and four with CPR for colic, yerba buena for of cough by the third day and improved the being processed. It is included pain, akapulko for skin ease of expectorations and disappearance of in the Philippine National Drug fungal infection, bayabas for phlegm for adults and pediatric patients with Formulary (PNDF). antiseptic, niyog-niyugan mild to moderate cough, it,” affirmed Maramba- for worms, ampalaya for Lazarte. Lagundi was among the adjunct treatment of diabetes, plants listed by the Philippine Because NIRPROMP’s research was funded by bawang as adjunct therapy for Department of Health in the Department of Science and Technology- hypercholesterolemia, pansit- October 1995, a list of officially Philippine Council for Health Research and pansitan or ulasimang bato for endorsed plants that exhibit Development (DOST-PCHRD), all intellectual uric acid.” effective natural medicinal property (IP) rights were managed and owned properties with proven by DOST and NIRPROMP before. In 1999, DOST therapeutic value along with applied for a utility model with the Intellectual Lagundi (Vitex negundo the nine other plants isolated Property Office of the Philippines that was L.) and Other Herbal through its earlier R&D. approved and issued in February 2001. In 2009, Breakthroughs Lagundi has relieved countless according to Republic Act 10055, otherwise individuals of cough of non- The development of modern known as the “Philippine Technology Transfer bacterial origin. lagundi-based medicine Act of 2009,” technology developed backed was the result of the herbal by government funding must be completely In 2015, sales of lagundi medicine research and transferred to entities, such as universities or reached PhP 155 M with annual development undertaken companies that can translate this technology profits from one hectare of by NIRPROMP Researchers into useful products and services. Based on lagundi ranging from PhP under Dr. Maramba with this new policy, PCHRD formally transferred the 163,000-553,000. "Aside from
The UP Manila Health and Life Magazine 26 the health part, we also want to its effect is comparable to Sodium thiosulfate. transfer document was help our farmers so that they Its technology transfer document was completed in 2008 and is would have new cash crops, completed in 1996, for inclusion in the PNDF included in the Philippine and also help the Philippine once the CPR is approved. Akapulko lotion is National Drug Formulary. It is pharmaceutical industry," licensed to 2 companies, with CPR in process. licensed to 2 companies with added Maramba-Lazarte. The its CPR being processed. Yerba buena (Mentha cordifolia) tablet is used successful commercialization as an analgesic in patients with acute moderate Ampalaya (Momordica of lagundi has also been to severe post-operative pain (post-dental, charantia Makiling variety) beneficial for the many farmers post-circumcision, post-episiotomy, post-tissue tablet is for treatment of non- that grow and sell the shrub to biopsy); its effect is comparable to paracetamol. insulin-dependent diabetes manufacturers. Its technology transfer document was mellitus type II. Ampalaya Sambong (Blumea completed in 2002 and licensed to 1 company tablet is comparable to balsamifera L.) or Blumea with its CPR in process. glibenclamide in reducing camphor tablet is another fasting plasma glucose by Tsaang gubat (Carmona retusa) tablet is for IHM success in the research of week 3, and decreasing gastrointestinal pain and biliary stone and biliary herbal medicines. Sambong HbA1c. Its technology transfer colic. In clinical trials, tsaang gubat tablet is tablet is used as an anti- document was completed comparable to dicycloverine. Its technology urolithiasis treatment in patients with urinary tract stones with normal kidney function and for diuresis. Survey of Traditional Healers on herbal medicines Its technology transfer was and folkloric used/Literature review completed in 1998. It is currently licensed to eight companies and included in the Philippine National Drug Choose herbal medicines for a specific indication Formulary. and screen for pharmacologic action
“At present, it is the market leader in anti-urolithiasis Pharmaceutical Agricultural Preparation medicine in the Philippines” Researches Preclinical Researches Researches declared Dr. Maramba-Lazarte. • Cultivation • Acute Toxicity She added that “sambong • Plant material • Propagation • Sub-chronic/chronic processing is heavily prescribed by • Harvesting toxicity • Crude drug nephrologists and urologists • Post-harvest • Safety pharmacology preparaion (Galenicals) even at the National Kidney handling • Mutagenicity, and Quality control Clastogenicity and Transplant Institute, that • Drug formulation • Heavy metal content and manufacturing in 2015, sales of Sambong • In vitro and in vivo research reached up to PhP 195M. bioassays • Quality control • Isolation of active of Pharmaceutical Other herbal medicines whose compound product efficacy was researched and validated by IHM were Akapulko lotion, Yerba Buena tablet, Tsaang gubat tablet, Human Trials and Ampalaya tablet. These • Phase 1 herbal medicines will soon • Phase 2 be available in the market • Phase 3 and are still available for technology transfer to other pharmaceutical companies.
Akapulko (Cassia alata) lotion Intellectual Property Rights/Herbal medicine registration with Phil FDA is for fungal infections caused by common dermatophytes; IHM Algorithm of Herbal Medicine Drug Development
27 Health Ripples in 2006. Clinical trials for the and cultivation of medicinal reformulation of tablets to plants, general principles for more concentrated form will community formulations of be carried out in 2018. medicinal plants, list of herbal medicines validated by the IHM, list of medicinal plants Merging of Science and for common symptoms and Traditional Medicine diseases, and list of toxic plants and treatment for Maramba-Lazarte discussed toxicity.” The book is written the three categories of herbal in layman’s terms and will be products that are out on the easily comprehended by any market in the Philippines, reader. namely herbal food supplements, traditionally She announced that IHM has used herbal products, and several projects going on this herbal medicines. year and will be presenting to the PITAHC for funding “When you register to the several projects in line for Food and Drug Administration next year. These include (FDA) for herbal supplements The 6th edition of the guidebook studies on herbal medicines and traditionally used herbal as antibacterial agents, products, you don’t need Why herbal medicines? ointments, oral lozenges and evidence of efficacy; you don’t as treatments for intestinal have to prove anything. You A lot of our modern-day worms, amoeba, malaria, just have to show that it is leptospirosis, and glaucoma. safe,” she explained why food products came from supplements and traditionally In terms of collaboration, IHM used herbal products should various plant sources. is working on partnerships put a label “No Approved Research in herbal with international institutions Therapeutic Claims” and “The and organizations for training Traditional Application or Use medicines usually takes and research. However, Dr. Has Not Been Evaluated by Maramba-Lazate still asserted the FDA.” 5 to 6 years compared that IHM research and patents should be maintained in the “In herbal medicines, a whole to the study of Philippines. lot of studies have to be done to be registered in FDA. It has conventional synthetic Maramba-Lazarte looks to undergo pre-clinical trials, forward to more productive phases of human clinical medicines that usually research. Sharing a quote trials,” she asserted. “The drug takes 10 to 15 years. that her mother, Dr. Maramba, development process is very lives by, “There will be a time similar to synthetic drugs. You when one’s mind cannot need much more evidence offer the technology transfer document to formulate new synthetic to be registered as herbal pharmaceutical companies, which, in turn, medicine, but God is always medicine, and that is what will manufacture and distribute the herbal there and his creation and the we in the Institute of Herbal medicine to the market. active principles created by Medicine do.” God will be the one to save mankind,” she asserted that Maramba-Lazarte pointed out IHM will continue to work for that after it has been proven Other Achievements and the advancement of herbal through research that herbal Future Goals of IHM medicines in the country to medicine is safe and effective, Dr. Maramba-Lazarte said that “Last October provide Filipinos with cheaper IHM will apply for patents to 2016, we organized the first Herbal Medicine but proven effective cures for the Intellectual Property Office Summit.” This 2017 we launched a book which common ailments. of the Philippines (IPO) and contains the general principles of propagation
The UP Manila Health and Life Magazine 28 The Philippine Health Information System-Mental Health Conditions: RAISING MENTAL HEALTH AWARENESS IN THE COUNTRY
Fedelynn M. Jemena
“Depression, for me, is like this: Imagine a full-colored picture of a park full of people enjoying themselves. It could be any picture you like. Just imagine it full-colored. The world is like that for me on most days. Then imagine that gorgeous colored picture suddenly dims to a pale gray, then a darker gray, then darker and darker until it turns black. It remains black for a while. Then a bright yellow doorway appears at the bottom right hand corner, like that NatGeo doorway? There’s an EXIT sign on top of it. It’s…It’s not a way to get back to that full-colored world. It’s a way out for me…I haven’t considered that doorway for a long while, probably because I meditate, but I still see it. I know that I keep it at the back of my mind, just in case.” – A Non-trad Healer
Three years ago, the confession above would have earned that person an uncomfortable look, not to mention disbelief and strong derision. Those days are not gone yet, as there are still many Filipinos who view a mental illness or disorder like depression as an attempt to attract attention or just trying to act like a rich person (De Jesus, 2017).But those days are slowly diminishing—slowly, as in snail’s pace.
But a snail’s pace is better Members of the “Into the Light” Project (July 2014): [Front Row, L-R] Dr. Dinah Nadera (psychiatrist than no pace at all. and President of Foundation Awit, an NGO); Mr. Jeffrey Go (Managing Director, Johnson & Johnson Philippines); Dr. Jacinto Blas Mantaring III (President, FACE, Inc.); Dr. Criselda Abesamis ( Director IV for Special Concerns Technical Cluster of DOH ; Prof. Maria Lourdes Amarillo (UPM NIH-ICE); Dr. Benita Ponio (Executive Director, Metro Psych Facilities ); and, Dr. Bernardino Vicente (National Center for Mental Health). Photo by: JA Bautista
29 Health Ripples On 2 May 2017, the Philippine Senate unanimously approved on 3rd and final reading Senate Bill 1354 or “The Mental Health Act of 2017“ (Elemia, 2017). The principal author is Senate Majority Leader Vicente Sotto III, while the co-authors are Senators Loren Legarda, Antonio Trillanes IV, Paolo Benigno Aquino IV, Juan Edgardo Angara, and Joel Villanueva. It is sponsored by Senator Risa Hontiveros.
On 20 November 2017, the the Philippines, one of the few countries in the 6. Tasking the Department House of Representatives world still without a mental health policy, will of Health to craft a new approved on final reading its have a lasting gift to its people. national mental health own version, House Bill 6452 program in coordination with or “Comprehensive Mental These movements by the legislative branch stakeholders, and; Health Act." All 223 lawmakers of government are due to the push of many voted in favor of it, with none sectors of society: health professionals, 7. Appropriation of a 5% voting against it or abstaining patients and their families, artists and actors, special budget from the (Cupin, 2017). It is authored ordinary citizens, students. Sin Tax collection for the by 67 Representatives initial implementation of the and sponsored by Law on top of the General Congresswomen Angelina Just what is the Philippine Mental Appropriations Act for 2017 Tan and Cristina Roa-Puno, Health Bill? and 2018. and Congressmen Romero Article 1, Section 2 of SB 1354 declares that Quimbo and Karlo Nograles. “The State hereby affirms the basic right of Just why is a national mental Considering the contentious all Filipinos to mental health as well as the health law important? nature of the Philippine fundamental rights of people who require Legislature, this smooth mental health services.” The World Health sailing of a bill can be Organization (WHO) defines The Bill ensures, among other things: considered a miracle. The health as “a state of complete remaining work, before 1. The delivery of an integrated mental physical, mental, and social submission to the Office of health service to any Filipino who needs well-being and not merely the President of the Republic, psychological care (better if you can cite the the absence of disease is for the consolidation of number of article or section), or infirmity” (Principles). It the two bills by a conference defines mental health as “as 2. Integration of mental health wellness committee and approval of a state of well-being in which programs in schools, this version by both Houses. every individual realizes his or On December 11, 2017, the 3. Establishment of community-based mental her own potential, can cope Bicameral Conference health facilities by local government units with the normal stresses of Committee of Congress (LGUs), life, can work productively and finished consolidating the fruitfully, and is able to make 4. Protection of the rights of the mentally two bills and will submit it a contribution to her or his ill as well as the rights of family members, for ratification. It is hoped community”(Fact Files: Mental caretakers, legal representatives, and mental that before 2017 ends, the Health). health care professionals, Philippine Mental Health Bill What is a mental disorder? Can will be ratified and signed 5. Creation of the Philippine Mental Health a person with a mental disorder into law by President Rodrigo Commission as an attached agency of the still be a functional, contributing Duterte. When that happens, Department of Health (DOH), member of society?
The UP Manila Health and Life Magazine 30 GLOBAL SCHOOL-BASED STUDENT HEALTH SURVEY
Students Aged 13-15 Years Students Aged 16-17 Years Students Aged 13-17 Years PHILIPPINES, 2015 Total Males Females Total Males Females Total Males Females
Alcohol Use
Percentage of students who currently drank alcohol (at least one drink of alcohol on at least one day 18.2 20.0 16.6 29.7 36.6 22.6 21.1 24.4 18.1 during the 30 days before the survey) (15.4-21.4) (17.1-23.2) (13.4-20.4) (26.4-33.1) (32.8-40.6) (18.8-26.9) (18.6-23.9) (22.0-26.8) (15.0-21.6)
Percentage of students who ever drank so much alcohol that they were really drunk one or more 16.5 18.6 14.4 31.5 36.8 26.1 20.3 23.4 17.4 times during their life (13.5-20.1) (15.3-22.5) (11.2-18.4) (28.4-34.7) (33.6-40.2) (22.4-30.2) (17.6-23.4) (20.5-26.6) (14.3-20.9)
Percentage of students who drank alcohol before age 14 years for the first time, among students who 67.0 68.9 64.9 30.5 32.5 27.9 54.9 56.1 53.5 ever had a drink of alcohol other than a few sips (63.1-70.6) (64.6-72.9) (59.8-69.6) (24.6-37.1) (26.8-38.7) (20.4-36.9) (49.6-60.1) (51.1-61.0) (46.7-60.1)
Dietary Behaviors
Percentage of students who were underweight (<- 10.7 13.0 8.7 10.8 15.5 6.3 10.7 13.6 8.1 2SD from median for BMI by age and sex) (9.2-12.5) (10.6-15.8) (7.1-10.6) (8.6-13.5) (12.1-19.6) (4.5-8.8) (9.3-12.4) (11.3-16.3) (6.8-9.6)
WHO defines mental the right medical care and social services. A The Department of Health, disorder (mental illness, person with a mental disorder can still be a in its “National Objectives mental disability) as a functional, contributing member of society. for Health Philippines 2005- health condition “generally 2010” (2005) book, cited the What is the Philippine mental characterized by some results of a disability survey health situation? combination of abnormal done in 2000 by the National thoughts, emotions, behaviour Dr. Edgardo Juan L. Tolentino Jr (Past President, Statistics Office: and relationships with others.” Philippine Psychiatric Association, January Mental illness was the third Some are mild and cause only 2014 – January 2015) cited a 2006 study done most common form of limited disturbance in daily by the DOH and the National Epidemiology disability after visual, hearing life, while others are severe Center: 32% of 327 government employees impairments enough to need hospital surveyed in the National Capital region suffer care. Some examples are from mental disorders. These disorders are 2. The prevalence rate of anxiety disorders, depression, anxiety, phobia, substance abuse (alcohol), mental illness in the country bipolar affective disorder, and depression. He said that these problems was 88 cases per 100,000 schizophrenia and other should not be dismissed. He also said that population, psychoses, dementia, and support of loved ones is very important 3. Regions with the highest developmental disorders like (Surara, 2015). prevalence rate of mental autism. A 2015 WHO Global School-based Student illness were Southern There are many causes of Health Survey of 8,761 students from Tagalog (132.9 cases/100,000 mental disorders: genes, Grades 7-9 and Year 4 reported that, for the population), National Capital life experiences (eg, from Philippines: Region (130.8/100,000 abuse, war, disaster), food population), and Central • Students who seriously considered deprivation or malnutrition, Luzon (88.2/100,000 attempting suicide during the 12 months traumatic brain injury, population). before the survey: 11.5% (13-15 years old [yo]), exposure to viruses or toxic 11.9% (16-17 yo), overall 11.6% (13-17 yo); chemicals while pregnant, substance abuse (alcohol, • Students who attempted suicide one or more Enter evidence-based illegal drugs), having a times during the 12 months before the survey: PHIS-MC serious medical condition 17% (13-15 yo), 16.2% (16-17 yo), overall 16.8% Convincing people to take (MedlinePlus). Mental illness (13-17 yo); mental health seriously takes a can happen to anyone. • Students who did not have any close friends: lot of hard work. Riddled with Most mental disorders can 4.2% (13-15 yo), 4.6% (16-17 yo), overall 4.3% negative misinformation (e.g., be successfully treated as (13-17 yo) that it is linked to insanity), long as there is access to hence, a taboo, having
31 Health Ripples PHIS-MC was rolled out among 10 government and four private hospitals in eight regions.
These hospitals were the Philippine General Hospital, National Center for Mental Health, Southern Philippines Medical Center, University of Santo Tomas Hospital, Mariveles Mental Hospital, Vicente Sotto Memorial Medical Center, Bicol Regional Hospital, Baguio General Hospital and Medical Center, Cavite Center for Mental Health, Veterans Memorial mental illness was a shameful, to be extended to all facilities.” Medical Center, Western painful subject for people To change the situation, a multisectoral Visayas Medical Center, and to touch. The thick wall of group teamed up to produce the country’s Metro Psych Facilities in Pasig denial raised by the sufferer, first integrated information system on and Cebu (Janssen, 2014) families, and friends made it mental health conditions. Known as the “Into (Dioquino, 2014). hard to get proper medical the Light” Project or the Philippine Health assessment and treatment… The project ran for several Information System on Mental Conditions as well as research data. Lack months before its initial results (PHIS-MC), it was launched on 22 July 2014. of significant research data of the pilot implementation means an incomplete mental The current PHIS-MC is a software which were reported by Prof. Amarillo health picture which can lead builds a database of information on mental and Dr. Tomas Bautista (a to low government priority for health cases, especially schizophrenia for consultant psychiatrist and improvement in mental health patients who consult the hospital. The doctors clinical associate professor facilities and personnel. collect the data and, thereafter, anonymize at the UP-PGH Department and upload them to the data center. Some of Psychiatry & Behavioral According to the 2007 WHO- hospitals adopt the system for their electronic Medicine or DPBM) in a multi- AIMS Report on Mental Health medical record. However, this does not mean stakeholder forum held in System in the Philippines: “The that patient-doctor confidentiality is violated. Intramuros in June 2015. country spends about 5% of It remains sacrosanct since data can be the total health budget on Based on the uploaded collected only with informed consent, while mental health and substantial records of 2,562 patients, 42% full access to the records remains between the portions of it are spent on the suffered from schizophrenia. patient and the doctor. operation and maintenance Majority of these were men of mental hospitals. The new It was the outcome of a grant given in aged 20-44. Dr. Bautista said social insurance scheme December 2013 by the Janssen Pharmaceutical that, based on the figures, it covers mental disorders but is Companies of Johnson and Johnson can be estimated that roughly limited to acute inpatient care. (Janssen Philippines) to the Foundation for one million of the population Psychotropic medications the Advancement of Clinical Epidemiology, suffer from schizoprenia. are available in the mental Inc. (FACE, Inc.) and the Institute of Clinical Other findings were: health facilities. A Commission Epidemiology of the UP Manila National •15% of the patients had on Human Rights of the Institutes of Health (UPM NIH-ICE). bipolar disorder, followed by Philippines exists, however, It was developed by a team composed of 6% with substance abuse human rights were reviewed Technical Working Group of psychiatrists of the (drug addiction); the other only in some facilities and only Philippine Psychiatric Association (PPA), UPM patients suffered from major a small percentage of mental NIH-ICE, and FACE, Inc. The project head was depressive disorder, anxiety health workers received Prof. Maria Lourdes Amarillo of UPM NIH-ICE. disorder (panic attacks), training related to human schizoaffective disorder, acute rights. These measures need
The UP Manila Health and Life Magazine 32 and transient disorder, and Behavioral Medicine (DPBM). stimulant related disorder; “Convincing people to take “All participating hospitals wanted to go on with the • Only 22% of the patients mental health seriously project, but...,” he shrugged. were covered by the They hoped that the DOH Philippine Health Insurance takes a lot of hard work. would offer to sponsor, but Corp. either as members (13%) its National Center for Mental or dependents (9%); Riddled with negative Health has its own version of • 29% said they have no misinformation, having the database to support. PhilHealth coverage, while Of the 14 hospitals, only PGH 49% did not indicate their mental illness was a could continue with the PHIS- PhilHealth status; shameful, painful subject MH as its DPBM has some • Approximately 65% of the research funds to tap. “We’re patients were between the for people. The thick wall still going on: printing the 14- ages of 22 and 44 years, of denial raised by the page Unified Clinical Intake according to Dr. Bautista, Form (used per patient) and which is alarming as these sufferer, families, and paying our own research are the productive years of assistant to encode data,” said anyone; and, friends made it hard to get Dr. Bautista. • 57% of the patients were proper medical assessment The PGH and NIH team males and 43% were females know that the local data (Uy, 2015). and treatment… as well is rich enough for national policies to be based on, Also at the forum were some as research data. Lack of so it began other projects. patients and their families who “We were informed that gave their testimonies. They significant research data Quezon City allotted funds emphasized the importance for its own mental health in patient recovery of means an incomplete program. We volunteered our continuous provision of expertise to do the training medicines and family support mental health picture which on this and the mhGap. group. Stigma also played can lead to low government The mhGap (Mental Health a part in the health-seeking Gap Action Programme) is a needs of some parents: to priority for improvement in tool formulated by WHO for protect their loved ones community mental health. We (and, perhaps, the rest of the mental health facilities and trained the barangay health family as well), they chose workers, nurses, and doctors private wards for their patients personnel.” on how to use this tool at the event if it meant paying very community level. In 2018, expensive fees. He also encouraged the people to conduct they will start encoding.” Dr. Vicente Belizario Jr, then a regular forums on the advocacy for the Dr. Bautista said that city DOH Undersecretary, found passage of a Mental Health Act (PNA, 2015). governments can approach the initial results good, but DPBM for training. not enough to convince “In another project, we the Department of Budget Into the Light partnered with Dr. Alvin & Management (DBM) to Unfortunately, just like a mental health patient Marcelo under eHealth as we allot a huge fund for the seeking a cure and social acceptance, the wanted to expand PHIS-MH mental health program. He PHIS-MH project hit a snag. In December 2016, to the communities. It will be challenged the stakeholders the project died a natural death. part of the Telehealth project.” to see the pilot study through Another version of the project, to completion so that all may “It died because there was no more funding,” much bigger as it will tap both see the challenges, lessons, said Dr. Tomas Bautista, a consultant hospitals and communities and best practices needed to psychiatrist and clinical associate professor nationwide, was presented by ensure a successful system. at the UP-PGH Department of Psychiatry & the team and Dr. Marcelo to
33 Health Ripples was a big jump from P36- million in 2016 (Santos, 2016).
Among our legislators, several cited the results of the PHIS- HM when they filed their bills: Senator Pia Cayetano for her SB 2910 or “The Philippine Mental Health Act of 2015,” House Representatives Leni Gerona Robredo (now the Vice President of the country), Romero Quimbo, Ibarra Gutierrez, Walden Bello, Karlo Alexei Nograles, Kaka Bag-ao, and Emmi de Jesus for House Bill No. 5347 (in support of Cayetano’s SB 2910); and Senator Risa Hontiveros for SB 1190 or the “Mental Health Senator Risa Hontiveros. The of the campus. The vision is to create a mental Act of 2016.” In November senator promised to include wellness program based on the gathered 2017, the House passed it as part of the Implementing evidence. Some of the studies produced its own version. (To be fair, Rules and Regulations (IRR) of relied on the local PHIS-MC data, like profiling several bills were filed since the Philippine Mental Health the patients from the different UP campuses, the 1980s to help our people Bill. “Prevalence of depressive symptoms among deal with mental health, but 1st year college students (ages 15-18) of UP Then, there are the researches. the push for their realization Manila,” “Prevalence of non-suicidal self-injury As of late 2016, two members into law was slow until some and suicide attempts among young adult of the PHIS-MH team, Dr. just ‘died’ including SB 1946 or college students of UP Manila,” and “PSWN has Bautista and Dr. Cynthia “Student Suicide Prevention need to define mission, vision, goals and group Leynes, completed writing the Act of 2005” by Senator objectives.” study presented to the multi- Miriam Defensor-Santiago stakeholder forum in 2015. It is Six more researches came out in 2017, said Dr. (Rodriguez, 2015). Those entitled, “Clinical Presentations, Bautista. The latest paper submitted was on early lawmakers included Interventions and Outcomes the prevalence of anxiety disorders and stress Sen. Orlando Mercado Jr and of Schizophrenia in the among UP Manila students. Sen. Joey Lina. (Among the Philippines: A Retrospective current batch of lawmakers, As of December 2017, Dr. Anselmo Tronco, Review of Cases included Dr. Bautista cited Sen. Loren head of the DPBM’s Psychosocial Wellness in the Philippine Health Legarda as the earliest to Program for UP Manila, is planning to talk with Information System on Mental advocate for a mental health Acta Medica Philippina for a whole journal Health Conditions (PHIS-MH) bill.) publication devoted only to the department’s prior to 31 December 2014.” researches. The Philippine Psychiatric The paper was submitted Association (PPA) launched in to the Philippine Psychiatric As a wake-upper, the results of the PHIS-HM 2015 an online petition called Association (PPA) for certainly added its weight in the growing “#MHActNow” at Change.Org publication in its Philippine clamor for a national mental health bill. aimed at urging legislators Journal of Psychiatry (PJP). It The DOH, in October 2016, allotted more than to pass the proposed mental will come out in January 2018. PhP1B for it 2017 budget for the upgrading of health bill. It garnered 34,619 The DPBM initiated a its National Mental Health Program (signed in signatories. Psychosocial Wellness 2001 by then Secretary Manuel Dayrit as DOH Groups like the Program for UP Manila. The Administrative Order No. 8) and facilities, and MentalHealthPH and Youth department is busy gathering P100 million for its medicines access program For Mental Health Coalition, data to identify the needs of for anti-psychotics or mental health drugs Inc. along with the Philippine the students and employees (ABS-CBN, 2017). The budget for the program Mental Health Association or
The UP Manila Health and Life Magazine 34 PMHA provided support for people with mental disorders, raise the awareness of
Filipinos about mental health, reduce the stigma attached to it, and improve the MH situation in the country by lobbying for improved services and a national MH law. The two youth groups sprung up in 2016, while the veteran PMHA has been active since the 1950s.
Also in 2016, a mobile application called PsychUP Mental health advocates: Actress Antoinette Taus, Miss International 2016 Kylie Verzosa, and “Be Healed was created by two UP Foundation” director Jerika Ejercito. Source: Alexa Villano/Rappler Diliman computer science with long-held prejudices here. It will take much time, patience, and work before students for use by their they’ll be gone from society, but they will be gone. fellow students. Described as a mental health first "It's truly the time to beat the stigma surrounding depression and other forms of aid kit, the campus-based mental illness. No one should have to go through depression alone... and it is now app was approved by the time, it's up to us to make sure that our countrymen get the help they need." administration for a test run – Antoinette Taus, actress and mental health advocate among UP Manila students. The app involved sending References: messages between a student De Jesus, Julliane Love. “Joey de Leon comment ‘saddening,’ but Tito Sotto appeals for understanding” Inquirer.net. Link: http:// newsinfo.inquirer.net/936068/joey-de-leon-comment-saddening-but-tito-sotto-appeals-for-understanding-depression-mental- and a guidance counseling health-risa-hontiveros#ixzz4zYtL6N73 6 October 2017 Elemia, Camille. “Senate approves mental health bill on final reading.” Rappler.com: https://www.rappler.com/nation/168627- peer. The anonymity of the senate-mental-health-bill-final-reading 2 May 2017 student is guaranteed (De Cupin, Bea. “House approves mental health bill on final reading.” Rappler.com: https://www.rappler.com/nation/189032-mental- health-bill-house-representatives-final-reading. 20 November 2017 Leon, 2016). World Health Organization. “Constitution of WHO: Principles.” Link: http://www.who.int/about/mission/en/ In 2016, HOPELINE, a 24/7 World Health Organization. “Mental Health: A State of Well-being.” Link: http://www.who.int/features/factfiles/mental_health/en/ crisis support hotline for World Health Organization. “Mental Disorders.” Link: http://www.who.int/mental_health/management/en/ MedlinePlus. “Mental Disorders.” Link: https://medlineplus.gov/mentaldisorders.html suicide prevention and Surara, Annabelle. “32% ng mga nagtratrabaho sa gov’t dumaranas ng mental health problems.” Net25 Live: Balitang emotional crisis, was launched Pangkalusugan (Eagle Broadcasting Corporation). 17 April 2015. Link: http://www.eaglenews.ph/many-government-employees- suffer-from-mental-health-problems/ under the partnership of 2007 WHO-AIMS Report on Mental Health System in the Philippines http://www.who.int/mental_health/evidence/philippines_ the DOH and the Natasha who_aims_report.pdf Press Release: “Stakeholders Roll-out PH’s first mental health information system.” Janssen Pharmaceutical Companies of Goulbourn Foundation (NGF). Johnson and Johnson (Janssen Philippines). 22 July 2014 Although a lauded move, Dioquino, Rose-Ann Jessica. “PHL’s first mental health information system rolled out.” GMA News. Link: http://www.gmanetwork. com/news/lifestyle/healthandwellness/371642/phl-s-first-mental-health-information-system-rolled-out/story/ . 23 July 2014 netizens report that there Note: It wasn’t smooth sailing. Prof. Amarillo said that, of the over 11,000 information sheets distributed to the participating are some problems with its facilities, only 9,066 (80%) were collected. Of these, 4,122 were encoded, but only 2,562 were uploaded into the system. She said the culprit was hospital wariness about sharing their records in the system. implementation (Francisco, Uy, Jocelyn R. “Schizophrenia top mental disorder afflicting Filipinos who seek help, says study.” Philippine Daily Inquirer. Link: http://newsinfo.inquirer.net/696823/schizophrenia-top-mental-disorder-afflicting-filipinos-who-seek-help-says- 2017). Hopeline, actually, study#ixzz3cSJPT1Ge. 8 June 2015 already existed before 2016, Philippine News Agency (PNA). “DOH Calls For Integrated Philippine Mental Health Information System.” Philippine Daily Inquirer. Link: http://opinyon.com.ph/index.php/rated-18/news/health2/351-doh-calls-for-integrated-philippine-mental-health- but only under the aegis of information-system 16 June 2015 NGF. ABS-CBN. “DOH allocates more than P1-billion for mental health programs.” http://news.abs-cbn.com/news/04/07/17/doh- allocates-more-than-p1-b-for-mental-health-programs. 11 April 2017. The shaking up of Philippine Santos,Tina G. “DOH’s mental health program boosted with P220M, AO.” Inquirer.Net: http://newsinfo.inquirer.net/825351/dohs- mental-health-program-boosted-with-p220m-ao. 14 October 2016. society when it comes Rodriguez, Fritzie. “Why do Filipinos need a mental health law?” Rappler.Com: https://www.rappler.com/move-ph/111100- to mental health will not filipinos-need-mental-health-act 1 Nov. 2015. “#MHActNow.” Link: https://www.change.org/p/mhactnow halt anymore. Will the MentalHealthPH (https://www.facebook.com/mentalhealthphilippines/); Youth For Mental Health Coalition (https://www. misunderstandings and the facebook.com/YouthForMentalHealth/); Philippine Mental Health Association or PMHA (http://www.pmha.org.ph/) stigma surrounding it be gone De Leon, Dwight Angelo. “UP students create mobile app for mental health first aid.” Rappler.com. https://www.rappler.com/ move-ph/137967-up-students-create-mobile-app-mental-health-first-aid next year? No, we’re dealing Francisco, Katerina. “How does the PH fare in mental health care?” Rappler.com. Link: https://www.rappler.com/newsbreak/ iq/184754-philippines-mental-health-care 10 October 2017.
35 Health Ripples Balik Scientists Tungo sa Kalusugan at Kaunlaran
Prop. Josephine D. Agapito
Ang tema sa nasabing pagtitipon* Balik scientists ay may pagkakataon Bilang katuwang upang gamitin ang agham sa nasyon Tungo sa pag-unlad ng kasalukuyan at sunod na henerasyon.
Dahil sa ibang bansa nag-aral at nagpakadalubhasa Kaya Balik puso, Balik Pilipinas at Balik scientists nga Upang magbahagi ng dunong at tulong sa bansa Ang pagiging maka-Filipino ay tunay na maidadambana.
Nagsimula noong 1975 ang Balik Scientist Program Naibalik sa DOST noong 1993 hanggang sa kasalukuyan Isang hakbang dahil marami talaga ang nangingibang bayan Nauubos ang mga siyentista at mananaliksik na sa pag unlad ay inaasahan.
Sa ilalim ng Department of Science and Technology Binubuo ang programa ng Steering Committee Ang PCAARRD; PCIERD at ang PCHRD Na siyang nangungunang mga Council sa DOST.
Sinabi ng kalihim ng DOST na si Dr. Fortunato T. De La Pena Tatlo ang ipinagdiriwang sa okasyon talaga Para ito sa mga bumalik na siyentista Na makakatulong sa bansa nang sobra.
Pangalawa ay para rin sa mga katuwang na institusyon Sa kanilang taos pusong pagtulong Kolehiyo, unibersidad; lokal na gobyerno ay naroon NGO, pribadong sektor o industriyang nagbigay ng pagkakataon.
Suporta ng nasa lehislatura ang siyang pangatlo Na naniniwalang mga siyentista ay dapat may mga insentibo Maisulong ang House Bill 1204 at maaprubahan ng Kongreso O ang Senate Bill No 1533 na maaprubahan naman ng Senado.
Kaya naman patuloy na mas pinalalakas ng DOST Ang pagtanggap sa mga Balik Scientists syempre Patuloy na lumalaki din ang bilang ng sumasali Para siyensa, teknolohiya at inobasyon ay umunlad na mabuti.
Sa huli ay mas umaasa pa na madadagdagan Ang mga siyentistang magbabahagi ng tulong sa bayan Sila na naniniwala sa sama-samang pagtutulungan Dahil ang agham ay para talaga sa ating mga mamamayan (Science for the People).
*Isinulat matapos ang nilahukang pagtitipon ng mga Balik Scientist noong Pebrero 2017
Josephine D. Agapito Guro sa Department of Biology, College of Arts and Sciences, UP Manila; host ng “Pinoy Scientist,” programa sa DZEC tuwing Linggo, 5 pm at nagsusulat at bumibigkas ng mga tula tungkol sa agham, kalusugan, at ibang mahahalagang paksa 37 Health Ripples