Journey to the Philippines Part 2: The Senate of the Philippines and the Philippine National Red Cross

FJ Volume 21, Number 17
September 05 - 20, 2007

Mabuhay! In Part 1 about my journey to the Philippines July 12th - August 10th, I reported on the Ambassadors’, Consul Generals’, and Tourism Directors’ Tour (ACGTDT) and my Field Practicum questionnaire for my Master’s in Public Health exploring the migration of Filipino doctors and health care workers to Canada. If you haven’t responded to the questionnaire yet, please take the time to do so (askdrdenise@mts.net or http://www.askdrdenise.blogspot.com/) as your much-needed input could form projects and initiatives to address the many difficulties Filipino HCWs face in Canada. Thank you po!

This issue chronicles my amazing experiences at the Senate and the Philippine National Red Cross with presidential candidate, Department of Tourism’s Wow Philippines “spear-header”, and humanitarian “extraordinaire” Senator Richard “Dick” Gordon. I had the great fortune of being seated on the flight to Manila close to Senator Dick who overheard me speaking of my ambitious project and graciously offered any assistance while in the Philippines. My project leads were proving difficult to contact, so I decided to take him up on the offer, just missing the opportunity to watch President GMA’s State of the Nation Address (Sayang naman!!). My disappointment was quickly assuaged by an invitation to check out the Senate the following day! So on July 24-25th, I had the privilege of witnessing the first Session for the Fourteenth Senate of the Philippines where the main issue was the discussion surrounding further action following a resolution by 17 of the 22 senators asking that the Senate support newly elected Senator Trillanes, to be able to sit at the Senate and perform his functions. The problem is this: in July 2003, a group of 321 armed soldiers who called themselves “Bagong Katipuneros” led by Army Capt. Gerardo Gambala and Lt. Antonio Trillanes IV, of the Philippine Navy took over (and apparently rigged with bombs) the Oakwood Premier Ayala Center service apartment tower in Makati City to show the Filipino people the alleged corruption of the GMA administration. This Oakwood mutiny effort was quickly thwarted, and Trillanes is currently incarcerated for an alleged criminal charge. Following this, he ran for senator, and won with more than 11 million votes. Interesting dilemma. Dissecting this issue further reveals many insights into the checkered and complex political and cultural history of the Philippines. I got to hear many compelling arguments from the various senators, ranging from the popular notion that he represents the people by such strong public support, that not allowing him to sit in the senate could be perceived as a human rights violation, the precedent of previous politician Mantolo being allowed to sit his duties, minimization of any harms that Trillanes would pose by letting him do his duties (unlikely flight risk, he’d only be 1 of 22 senators so his influence would be “diluted”, options for security and teleconferencing), etc. Hmmmm. I also heard from the four senators (Gordon, Arroyo, Enrile, and Santiago) who voted against the resolution—mainly the separation of powers of jurisdictions, the gravity of the charge, the importance of accountability in the definition of courage, the slippery slope argument, the moral problem with the senate stepping outside its jurisdiction, the inherent conflict of interest in a senate essentially allowing one of its own to “be above the law”, and much more. I got to discuss the ethical and moral facets of the issue with Senator Gordon, before his final speech—this would not even be happening in Canada!-- and I must say, we were all proud that he “nailed it” by getting his points across so passionately and eloquently. There are 5 clips of his speech (with me in the background trying to tape it!) on http://www.youtube.com/watch?v=eKhUi7vSE98. The ante was upped when it was suggested each senator reveal the reasons for her/his vote, and though the resolution was passed, it was exciting to witness government in action, as well as see the media frenzy that followed the session.

Afterward, I saw his dedicated staff work late into the evening while he met with Filipinos who came to ask for his help and guidance, did an inspiring interview (and mini cultural and history lesson) with an Italian-Filipino initiative called Stila Magazine, foto-op with a Filipino-American hip-hop group, another interview with a group of elementary students, and a general debriefing with his staff. On top of all these great experiences and learning opportunities, Senator Gordon facilitated my project work with the Dept of Labour and Employment/Philippine Oversease Employment Agency as well as some time with the Philippine National Red Cross.

I sat in on a teaching session he held with his PNRC staff on Disaster Response Planning, and I got to put my two cents in on what some of the Canadian programs do. I also got to attend the meeting of the Board, which Senator Dick chairs. What an illustrious and welcoming group! Discussing the ins and outs of humanitarian work and the challenges of administering and managing public care and aid through the PNRC were both educational and inspiring to me as a budding public health specialist. My heart grew with pride when a couple of Filipinas from Canada dropped in to give a donation.

At the end of the meeting, we found that former President Fidel Ramos was at the PNRC getting his blood pressure checked! My blood pressure went through the roof as I joined the crowd to meet “Steady Eddie”, the beloved president I read about in my (and the first) Philippine Studies Institute class only a couple of weeks prior. He cajoled the gang and the foto ops and smiles were endless. I was able to set up an interview with him, so more about him soon.

To crown off the evening, I joined Senator Dick’s staff in catching the tail end of the year-long-awaited nail-biting basketball game between the rival universities - Ateneo vs De La Salle. The standing-only half-green (DLSU), half-blue (ADMU) crowd went wild the whole game, which went (close match in over-time) to Senator Dick’s home team, Ateneo.What a rush!

All in all, I was really impressed with Senator Gordon and what he stands for, especially his continually connecting Filipino history, culture—identity--to the future of the Philippines in a positive light, particularly with the young Filipinos who often need reminding of our colourful past and why things are the way they are in the Philippines. Looking at the difficulties in life Filipinos face, it seems so easy to forget or even divorce from the country’s past, and embrace the “new” whether out of a sense of shame or survival. This man, through his example to everyone he meets, has given me a true appreciation for the different pieces of a puzzle I’d been trying to work out for quite some time now: tourism/economy and social business, history, culture, human rights and humanitarianism, health of individuals and populations, hard individual work with collective spirit and mentality, all mixed with a fierce love of two countries. I learned so much, and I could see how he ignites others to be their best. I feel very blessed to have been able to see so many great facets of the Filipino people, and to experience Filipinos working in earnest to better the country. Thank you, Senator Dick!

Well, that about caps up this article. So, folks, please remember that your health (physical/body, emotional, spiritual, mental) is foremost in your own hands; health starts at home. Alagaan ninyo ang katawan at kalusugan ninyo! Until next time, take care, and mind your health!

Journey to the Philippines, Part 1: ACGTDT & MPH Field Practicum

FJ Volume 21, Number 16 
Aug 20 - Sep 05/07

Magandang araw mga kababayan! It feels good to write after a long-enough hiatus—I just got back August 10th from our homeland, the Philippines, after a month jam-packed with cultural events, adventures, meetings, opportunities, and overall major personal growth. What a lot to report, and where to begin?? I guess at the beginning…this will be Part 1 of a series that will include the ACGTDT, my Field Practicum research, experiences at the Senate and Philippine National Red Cross with Senator Richard Gordon, a trip to Subic to meet PGMA, and interviews with former president, Fidel V. Ramos, Migrante International, previous Secretary of Health Dr. Jaime Z. Galvez Tan, UP College of Medicine Dean Alberto Roxas, Sandra Aguinaldo from GMA-7, agencies including the Canadian Immigration Integration Program/Canadian Embassy, Philippine Overseas Employment Authority, Department of Labour and Employment, several physicians and medical students, “undercover” research in the form of “kidney-shopping” with cab-drivers, a stint at Operation Smile with Drs. Hector Santos and the Managed Care Clinic, and I might even reveal some of my more candid reactions, culture shocks, and rude awakenings learning about the distinctly Pinoy way of life. I will be posting my articles on my blog Ask Dr. Denise and its “angry” off-shoot POP soon, so if you miss any, feel free to check out the blogs at: http://www.askdrdenise.blogspot.com/.

As many of you may know, I am completing my Masters in Public Health degree, which requires a 3-month Field Practicum, as part of my Community Medicine residency. I reasoned—what better way to work on a project I am passionate about that fits precisely into my world vision and life mission, with an opportunity for exposure and immersion at multiple health-related organizations and initiatives/programs, particularly my homeland, working on the many projects I have been toiling away in my spare time that are potentially good for the health of the Filipino and Canadian people, the health of the overall systems of my two beloved countries, and all involved? Plus I’d get to learn so much more about my roots, the language, the culture--a true Win-Win.

So I decided to start my Philippines portion of my practicum piggy-backing onto the 3rd Ambassadors, Consuls General and Tourism Directors Tour of the Philippines (ACGTDT), July 14-17, 2007. The weeks prior to my departure July 12 involved making last-minute preparations and finalizing trip plans, celebrating Philippine Independence and Heritage, plus taking in what I could of the Philippine Studies Institute first course History and Culture of the Philippines with Dr. Michael Culinane, including the very relevant forum to my project on The Brain Drain of Filipinos to North America. What an excellent and timely course and associated events schedule to kick off my trip to the Philippines!

The ACGTDT to the Philippines is a joint collaboration between Philippine government offices (the Departments of Foreign Affairs, of Tourism, and of Trade and Industry), designed to bring the Philippines closer to communities in North America, offering participants countless opportunities in terms of cultural enrichment and people-to-people exchanges, leisure and recreation, retirement programs and business networking. Of the almost 650 tour participants, 21 booked or came from Agana, Guam, 9 from Atlanta, 50 from Chicago, 114 from Honolulu, 146 from Los Angeles, 11 from Miami, 69 from New York, 130 from San Francisco, 29 from Washington DC, 7 from Calgary, 26 from Edmonton, 22 from Ottawa, 3 from Vancouver, and 10 from Winnipeg. The Winnipeg group included: Dr. Salvador and Josephine Andres from Saskatoon (my parents are Dr. Sal’s godparents), Alexandra, Luz, Nemesio, and Victoria Buen, Allen, Esmeralda, and Kelly Joe Harvard, and Antonina Huypungco (I booked through Ottawa as Hon. Jose S. Brillantes was my preceptor for the Philippine portion of my MPH FP).

We arrived groggy at just after 4 am July 14 to the welcoming tunes of a Filipino “mariachi band” and fragrant sampaguita leis. A quick orientation at the Shangri-la Makati Hotel, and we were whisked to the Serendra Club House for breakfast care of Megaworld Inc. and business meetings courtesy of the department of Trade and Industry. Here we learned of small investment opportunities in the provinces, Philippine brand franchising opportunities, the OTOP (One Town One Product) initiative, Meycauayan Jewelry Industry Association, etc. We could then mingle, sample more delicious Filipino foods, check out and purchase Filipino jewelry, and then embark on a City Tour of Manila and Makati which included Intramuros, Fort Santiago, and Bahay Tsinoy while some opted for Pasarap (spa/massage) or Paganda (mani/pedicure or haircut) for a small fee. We became VIPs when we were escorted by motorbike-police through the traffic-jammed streets of Manila to help get us to our “Exotic Mindanao” welcome dinner at the Sofitel Philippine Plaza. Canadian Ambassador Peter Sutherland joined us as we were wowed by an eye-popping Muslim Filipiniana song/dance/fashion-show where the beautiful dancers, singers, and models show-pieced the Mindanao delicacies served from the stage onto our plates, all emceed by a former Miss Philippines. After the dinner, I got to tsis-mis more with delegates from Ontario, Montreal, and Alberta when the Ambassador treated us to a late-nite coffee across the street from the Shangri-la Makati Hotel.

Sunday after another scrumptious breakfast, we got to choose from tours to Corregidor, Villa Escudero, or Tagaytay. I chose the Taal/Tagaytay/Batangas Eco-Cultural Tour, and was impressed by the serene drive through the countryside and the gorgeous landscape featuring the smallest Taal volcano, all to the silly jokes of our tour guide. We stopped for a merienda at the Tagaytay Highlands in a pagoda-style tearoom, then traveled to and lunched at the famous Sonya’s Garden. We stopped by the Tagaytay Medical Centre as one of our delegates had an asthma attack, but once we were assured of our group’s safety and health, we made it back in time to go to either a Show and Dinner in Tiendesitas Stalls, Ortigas, or Star Studio, ABS-CBN Cocktails with “stars”. I got a chance to have my first Krispy Kreme Donut at Star Studio, then hung with stars from Pinoy Big Brother and other famous Filipino teen shows. I also got some photo ops with the 2 Miss Teen American Philippines and camped it up in front of the camera some more with the teen Pinoy and Pinay hotties.

Monday started with a Wreath-Laying Ceremony in the brilliant (and unforgiving!) sun at Rizal Monument to give respect and honour our national hero, Jose Rizal. Then we arrived at Malacanang Palace for a Tour of the Museum—if anyone finds copies of the cheeky fotos of me showing off my shoes “Imelda-style” at the table where Marcos declared martial law, please let me know!!--then another belly-stretching lunch complete with Halo-Halo and other Filipino goodies. We met and got photographed at Rizal Hall with President Gloria Macapagal Arroyo, who at first thought the Canadian group was all from Winnipeg and had many wonderful things to say about our awesome province. She and her staff graciously chatted with and took photos with the throngs of delegates who swarmed her. We returned to our hotels via a Rolling Tour of Manila and Makati (included the Cultural Center of the Philippines Complex, Libingan ng mga Bayani, American Cemetery, Forbes Park, Business District) then finished up with a Wellness theme Appreciation Dinner at the Shangri-La Hotel. Here, we could dance the night away to the live bands or hunt through the stacks of tour photos from the tour photographers.

The following day was check-out for some while others could choose from Optional Out-of-Town-Tours such as Aklan/Boracay; Laoag/Vigan; Bohol/Dumaguete; Cebu/Cagayan de Oro; Puerto Princesa, Palawan; Diving in Club Noah Isabelle, Palawan; Golf in Metro Manila’s top 3 courses; Clark, Pampanga/Subic, Olgangapo; as well as a Gawad Kalinga Housing Project Visit and Wowowie Show. All in all the ACGTDT 2007 was an amazing time filled with wonderful experiences and connections with new friends from all over North America and the Philippines. I opted to focus on my ambitious project of looking at the Migration of Health Care Workers, particularly Filipino Doctors, to Canada. I will have to report on this project in an upcoming issue, but I am calling out to you to send me your stories, comments, or advice, or the contact information of those who might be able to help me in this ongoing project:

As I may have mentioned to many of you, I am quite interested in the experience and health of Filipino immigrants, particularly Live-in Caregivers, “nannies”, and health care professionals—whether recognized in their professions or not (credentials, fair and equitable pay, respect, etc). In my Public Health training, I’ve come across some research about the “Healthy Immigrant Effect”—basically that some immigrants tend to be healthier than Canadian-born but then after several years in Canada, their health deteriorates to the level of their Canadian-born controls. I’ve started researching the health of Filipinos across Canada and spent some time in Ottawa, Montreal, the Philippines, as well as locally talking to people about their experiences coming to Canada. I want to hear from you—please, tell me your stories: email me at askdrdenise@mts.net or go to my blog www.askdrdenise.blogspot.com and add your story as a comment to this article or take the questionnaire (to be set up)—if you wish certain parts of your story to be confidential, please use my email address and outline which parts, if any, you are okay with me sharing on my blog or in this column.

The questions I’m particularly interested in:

1) Name, sex, and contact information
2) Age, Year of Birth, Year of immigration to Canada, Dates of any other Caregiving experiences in other countries (including the Philippines)
3) Languages (including dialect, if necessary) spoken and read
4) Process of Immigration to Canada: Were you in the Live-In Caregiver Program, other categories of immigration
5) What type of work do you do? If you are a Caregiver, what field/area are you in? Ie: what training did you have in the Philippines, Canada, elsewhere? Did that translate into what you are doing now?
6) Health status/concerns in the Philippines compared with in Canada
7) Do you believe that being Filipino makes you healthier or less healthy than non-Filipinos? Why? What are the key factors you believe determine Filipino-Canadian health (eg, language, where born, credentialing, education, discrimination/prejudice, connection to community, family, etc)?
8) What are your concerns regarding the health of the Filipino community in Canada and in the Philippines? Is there a Brain Drain? Why or Why not?
9) What are your suggestions for dealing with these issues?
10) Any other comments are greatly appreciated.

Maraming salamat po!

So please remember that your health (not just physical/body, but also emotional, spiritual, and mental health) is foremost in your own hands; health starts at home. Alagaan ninyo ang katawan at kalusugan ninyo! Until next time, take care, and mind your health!

In Deed

FJ Volume 21, Number 11
June 05 - 20, 2007

'Ako ay Pilipina, indeed.'

That is the stinging concluding remark from a letter to the editor in response to my proud self-statement (a reference to the song Magdaragat introduced me to which eventually helped reconnect me to my heritage) in my FJ article on Folklorama when I first moved to Winnipeg in 2003. Ar-ouch. To this day, 4 years later, I can feel my blood pressure rise and my heart sink when I recall the experience. The writer was not happy with my use of the word “Flip” to refer to Filipinos, apparently considered derogatory by some. I was shocked at the strong negative reaction and attack at not only my character but also my definition of myself as a Filipina—ang bilis bilis, too!--because all my life, that word was a special term, almost of entitlement—like my “peeps”, my “homies.” This was the term my barkadas, a handful of Saskatchewan Filipino-Canadian teens—The Filipinas Youth Group, used to call ourselves—we were cool because we had something no one else did. Like a mini-gang minus the drugs and guns and scare factor. We wore bandannas and break-danced like no other. Heck, we dominated in the dance realm. I don’t know where Bagets (form of dance Magdaragat taught us) originally came from, but it became ours. We serenaded and pen-pal’ed with our Magdaragat friends like it was going out of style. We kicked butt in basketball and sikaran. No one could touch us. Looking back, it was par for the course; identity issues--what all teens go through.

Now 20 years later, that letter triggered another mini identity crisis—I was seeking any reassurance I could get from my parents and the FJ editors. Did I just offend the entire Filipino community with my words?? Was I any less Filipino because that word was power where I came from but here—a cause for immediate ostracism? And why didn’t anyone teach me this in Coconut School??! What about my lack of Tagalog? Or my Chinese blood and Chinese name? What do I do to “fix” this?? Dare I ask the question--who’s “more Filipino” here: someone who tries to build up the Filipino spirit in all its different forms despite glaring “un-Filipino-ness”, or someone with the privilege of breeding & birthright who tries to break it? I think I’d take 10 puti in barongg tagalogs singing our anthem off-key over 1 “purebred” Pinoy holding a gun to another. But that’s just “You’re-not-Filipino…No-you’re-not”–me. I still ask random Pinoys I meet about that word, because I do not want to give up that word; I refuse to give up that pride I’ve associated with it.

With time, I realized that if I wanted to resolve this inner disquiet, I best put my money where my mouth is. I went on a Medical Mission to Catanduanes, and saw and learned so much I hadn’t realized about my heritage. I decided to put my writing skills with my medical knowledge to do something good for the Filipino community—hence my health column, Ask Dr. Denise was born. To better understand our community and culture in addition to trying to serve the community, I ran for the PCCM Board and am now the Communications and Marketing Committee Chair. I started Tagalog/Filipino language classes, and everyone has been really great at encouraging me to use what I’ve learned. I joined the Asian Heritage Society in my quest to help increase the Filipino voice and profile in Manitoba. I am doing what I can to give back to an amazing community that embraced me with barbecues and socials and kain and baon.One of my crowning glories was when I reclaimed my Philippine Dual Citizenship when I visited Ottawa mid-April, while I was there to represent the Canadian Association of Internes and Residents (CAIR) at the Canadian Medical Association Council for Health Policy and Economics meeting. Our Embassy was gracious enough to facilitate the process of documentation requirements with my parents in Regina so that I could pledge allegiance to the Philippines at the Embassy during my trip. I was ecstatic as well as teary-eyed to achieve such an important validation of who I am. I also got my shiny new Pilipinas passport, so it was like winning the lottery!I still get the comments that I am “not Filipino enough” and “too Canadian.” I can only respond by accepting these stinging remarks and actively doing what I can to dispel these beliefs—not for my ego (I know full well who I am and have never hidden this), but because in my vision of what our Filipino community in Canada could become, these attitudes drive people apart rather than pull together as a family, and I must address this. Thus I must sincerely invite and encourage any of my kababayan to please feel free to come directly to me with any concerns they have about my actions/behaviours in the Filipino community. This is not at all a challenge, but an honest plea to the community to help me in this vital aspect of my life. Hopefully through my actions and deeds for the Filipino community, I can gain the acceptance of those I hope to advocate for.

In this way, I feel I can say, truly,

Ako ay Pilipina, in deed.

Food Safety: Bring on the Baon! & The Health of Caregivers

FJ, Volume 21, Number 5
March 05 - 22, 2007

My boss (I’m a live-in caregiver) is always on my case about food and leftovers. She wants to throw everything away which I think is very wasteful. I was brought up to be thrifty and frugal. Who is right?

You both are. Baon (food taken home from a party or gathering) is a central part of Filipino culture and in my opinion reflects our love of food and thriftiness, as well as resourcefulness and hospitality. We can always tell a Filipino fridge—not just by the jars of jufran, macapuno, bagoong, matamis sa bao (sometimes way past the expiry date!), but also an array of things like: little bowls of patis/soya sauce/kalamansi, Styrofoam plates of pancit, rice, adobo, stew, and cake/pastries covered by tin foil, a pot of sinigang, maybe some of those bright fuschia salted eggs, etcetcetc. Often the rice stays on the counter in the rice cooker which stays on “Warm”, 24 hours a day, 7 days a week. I am always a little scared of my parents’ fridge back home—packed with all sorts of things that I’m not sure are edible anymore and actually emitting loud whirring noises…I think it’s trying to tell my parents that it’s working too hard and should be relieved of its burden! Then there’s the trend for excessive oil use in Filipino cooking, but I think I covered that in my cholesterol article…naman!

Baon is definitely distinctly Filipino, but it can be dangerous.The Canadian Food Inspection Agency (CFIA) is the Government of Canada’s science-based regulator for animal health, plant protection and, in partnership with Health Canada, food safety. Their website (www.inspection.gc.ca) has a lot of useful information on issues related to food, including a list of allergy alerts and food recalls. You can search on it by country—there was a list of products from the Philippines that the CFIA considered unsafe. I remember going into severe withdrawal when they pulled the Nata de Coco jelly cups off the shelves—I’d loved them so much it was hard to hear that kids were choking on them! The CFIA site also provides a useful Food Safety Fact Sheet on Leftovers that I am quoting below. You can also find food safety information on the Health Canada and Canadian Partnership for Consumer Food Safety Education Web sites respectively at www.hc-sc.gc.ca and www.canfightbac.org/en/.

FOOD SAFETY FACTS ON LEFTOVERS
What is foodborne illness?
Food contaminated by bacteria, viruses and parasites can make you sick. Many people have had foodborne illness and not even known it. It’s sometimes called food poisoning, and it can feel like the flu. Symptoms may include the following:
* stomach cramps
* nausea
* vomiting
* diarrhea
* fever
Symptoms can start soon after eating contaminated food, but they can hit up to a month or more later. For some people, especially young children, the elderly, pregnant women and people with weakened immune systems, foodborne illness can be very dangerous.

Public health experts estimate that there are 11 to 13 million cases of foodborne illness in Canada every year. Most cases of foodborne illness can be prevented by using safe food handling practices and using a food thermometer to check that your food is cooked to a safe internal temperature!

Storing leftovers
* Store leftovers within 2 hours of cooking. Discard leftovers if the food has been sitting at room temperature for more than 1 hour. Cold food should be stored at 4ºC (40ºF) or colder.
* Before and after handling and preparing leftovers, wash your hands and sanitize all utensils, dishes and work surfaces with a mild bleach solution (5 ml/1 tsp. bleach per 750 ml/3 cups water).
* Never remove a large pot of food (such as soup, stew, or pasta sauce) from the stove and place it in the refrigerator. Large masses of food can take hours or days to chill properly. A slow cooling process provides an ideal environment for the growth of harmful bacteria.
* Very hot items can be cooled at room temperature, until they stop steaming, prior to being refrigerated. Frequent stirring accelerates the cooling at this stage. Food will cool faster in an uncovered, shallow container.
* An effective way to cool and store hot leftovers is to lay them flat in zipper-type plastic bags. Although the bags must be closed securely, food cools quickly due to the greater surface area exposed to the refrigerated air.
* Refrigerate or freeze leftovers in covered, shallow containers.
* Place containers on wire refrigerator shelves to allow air to flow across the bottom of the container. This practice allows food to cool twice as fast as sitting on a solid shelf.
* Do not overcrowd your refrigerator. Leave airspace around containers to allow circulation of cold air. This will help ensure rapid, even cooling.
* Date leftovers to ensure that they are not stored too long – eat leftovers within 4 days. For frozen leftovers, eat within 4 days of being taken out of the freezer.
* Always put leftovers in clean containers and never mix them with fresh food.

Reheating leftovers
* Reheat solid leftovers to at least 74ºC (165ºF).
* Reheat soups, sauces and gravies to a rolling boil.
* Follow the manufacturer's instructions when reheating commercial foods in a microwave.
* Discard uneaten leftovers after they have been reheated.

NEVER use your nose, eyes or taste buds to judge the safety of food.
You cannot tell if a food may cause foodborne illness by its look, smell or taste.
And remember: "If in doubt, throw it out!"
***
Now, some of you may know that I am quite interested in the experience and health of Filipino immigrants, particularly Live-in Caregivers, “nannies”, and health care professionals—whether recognized in their profession or not (credentials, fair and equitable pay, respect, etc). In my Public Health training, I’ve come across some research (some flaws in research design, etc) that talks about the Healthy Immigrant Effect—basically that some immigrants tend to be healthier than Canadian-born but then after several years in Canada, their health deteriorates to the level of their Canadian-born controls. I’ve started researching the health of Filipinos across Canada and spent some time in Ottawa and Montreal as well as locally talking to people about their experiences coming to Canada. I want to hear from you—please, tell me your stories: email me at askdrdenise@mts.net or add your story as a comment to this article or take the questionnaire (to set up)—if you wish certain parts of your story to be confidential, please use my email address and outline which parts, if any, you are okay with me sharing on my blog or in this column.

The questions I’m particularly interested in:

1) Name, sex, and contact information
2) Age, Year of Birth, Year of immigration to Canada, Dates of any other Caregiving experiences in other countries (including the Philippines)
3) Languages (including dialect, if necessary) spoken and read
4) Process of Immigration to Canada: Were you in the Live-In Caregiver Program, other categories of immigration
5) What type of work do you do? If you are a Caregiver, what field/area are you in? Ie: what training did you have in the Philippines, Canada, elsewhere? Did that translate into what you are doing now?
6) Health status/concerns in the Philippines compared with in Canada
7) Do you believe that being Filipino makes you healthier or less healthy than non-Filipinos? Why? What are the key factors you believe determine Filipino-Canadian health (eg, language, where born, credentialing, education, discrimination/prejudice, connection to community, family, etc)?
8) What are your concerns regarding the health of the Filipino community in Canada and in the Philippines?
9) What are your suggestions for dealing with these issues?
10) Any other comments are greatly appreciated. Salamat po!

So please remember that your health (not just physical/body, but also emotional, spiritual, and mental health) is foremost in your own hands; health starts at home. Alagaan ninyo ang katawan at kalusugan ninyo! Take care, and mind your health!

The Myths of Immunization

FJ Vol 21, No 2
Jan 22-Feb 5/07

We have heard a lot of bad/conflicting things about vaccination, and are not sure whether to vaccinate our children and ourselves. What do you think?

Immunization/vaccination is a hot topic in many circles, and many dangerous myths abound. I like to frame the approach from two perspectives—the population and the individual.

From the population perspective, it is an undisputed fact that immunization is one of the greatest success stories of modern medicine. Childhood immunization has saved millions of lives by eliminating many serious childhood diseases. Because of its success, we often no longer hear about many of these diseases, so it’s easy for parents to become complacent about the need to have their kids fully protected and keeping immunizations up to date. However in recent years, several countries have experienced new outbreaks of diseases everyone thought had disappeared—like diphtheria, German measles and polio. They reappeared because governments relaxed their immunization programs or certain groups in the population refused these immunizations.

It is true that as with any medicine, there are very small risks that problems could occur for someone getting a vaccine. From the individual perspective, many people think that since the risk of getting the disease is remote, they are saving themselves any risk of these potential adverse effects from getting the vaccine. However, this logic relies on the rest of the population to get immunized and decrease the risk of potentially fatal diseases occurring in the population. The higher the number of people who do not immunize themselves or their children means the higher the risk for the whole population. For all the vaccines currently offered in Canada/by Manitoba Health, a person’s chance of being harmed by the infection (and the severity of the illness) is far greater than any chance of being harmed by the vaccine. Vaccines are among the safest medical interventions, and they are subjected to rigorous safety and quality control standards. The individual must consider that once a person contracts the illness in question, the consequences could be disastrous. This is even worse, because the illness was vaccine-preventable. It is extremely important to weigh the right factors and not let overblown fear of an unlikely adverse event prevent protection from a potentially fatal and very real disease.

The vaccines currently recommended for adults and children will protect you/your kids against serious diseases that have not disappeared from the world. If people stop using these vaccines, the diseases will almost certainly become common again, causing many illnesses and deaths. These vaccines are extremely safe and highly effective. If you have any questions or concerns about vaccines, check with your doctor or public health office.

Many people go to the Internet looking for up-to-date information about vaccination. You can find current and trustworthy information on the Internet, but some websites have information that can be misleading—although they have been designed to look scientific and accurate, the information may not be scientifically valid. So remember: anyone can create a website. Only proper research methods guarantee the information is trustworthy. Always check the source of the information you read.

A trustworthy website will:
- Purpose
o …have a clearly stated mission and purpose
o …give credible health information based on solid scientific research
o …give info that includes many points of view. Be careful of sites that support a specific cause, group, or source of funding!
- Sponsors:
o …give the sponsor’s contact information; reputable websites don’t hide their identity
o The website address (URL) can help you learn more about them. If the address ends in:
".edu" = it is a school, college or university
".gc.ca" = Canadian government
".ca" = Canadian-based sites
".gov" = U.S.’ government
".org" = non-profit organizations
".int" = international organizations
".com" = commercial sites
- Supporting Organizations:
o …Be endorsed by a health agency/association you can trust.
o …Give info that covers municipal, regional, national or international concerns, not just the views of one person
o …Indicate if it’s part of a network of partners and identify them
o …Give background info about the sponsors
o …Refer to organizations responsible for maintaining standards
- Site Maintenance:
o …Have experts review the information
o …Post new info on a regular basis; often give the date when the info is posted.
- Authors:
o …clearly state the names of authors, their background and experience in vaccination/immunization. Look for details such as university degrees and professional membership in medical, nursing, scientific or public health associations
o …post work by authors who have published articles in established journals. Beware of articles written by “world-famous researchers,” “well-known scientists,” or “noted experts.”
o …give info based on solid research, not on opinion.
o …give references and links to support its statements
Beware:
- websites’ claims that seem too good or too bad to be true
- claims based on the idea of conspiracy; sites that say it discovered “the hidden truth” about vaccines
- information based on emotion rather than scientific fact. Stories about children who became sick or died are hard to read objectively. Even when pain and sickness occur, be aware that there is no substitute for scientific study.
- Information based on facts that aren’t tested. Professional researchers aren’t afraid to say that further research may be required.
- Websites focused on selling books, newsletters or products.
- Sites that give info “for educational purposes” only but don’t recommend a course of action—If a site is not willing to take responsibility for its advice, why should you?

Recommended websites:
- http://www.gov.mb.ca/health/publichealth/cdc/schedule.html: Manitoba Health’s website gives the routine childhood immunization schedule and links to the publicly-funded vaccines.
- www.immuniza.cpha.ca: Canadian Coalition for Immunization Awareness and Promotion
- www.caringforkids.cps.ca: Canadian Paediatric Society
- www.phac-aspc.gc.ca: Public Health Agency of Canada
- www.canadian-health-network.ca: Canadian Health Network
- www.cdc.gov: Centers for Disease Control and Prevention (U.S.)
- www.immunizationinfo.org: National Network for Immunization Information (U.S.)
- www.immunize.org: Immunization Action Coalition (U.S.)
- www.childrensvaccine.org: Children’s Vaccine Programs (U.S. and international partners)
- www.who.int/vaccines: World Health Organization

So please remember that your health is foremost in your own hands; health starts at home. Alagaan ninyo ang katawan at kalusugan ninyo! Take care, and mind your health!

Holiday Health

FJ Vol 20, No 24
Dec 15-31/06

One of my friends is new to Canada and is unable to make it home to the Philippines to visit her family. She seems sad all the time, and I think she is depressed. What should I do?

Christmastime is a very difficult time for many people, and problems related to depression and anxiety/stress are more common during this time. Some key features of depression include sad mood, decrease/loss in interest/pleasure, feelings of excessive guilt/worthlessness, decrease in energy/fatigue, indecisiveness or poor concentration, decrease/changes in appetite/weight, sleep disorders, and recurrent thoughts of death or suicide. If your friend has any of these symptoms, you should urge her to see a doctor or health care professional to get help. Her doctor may prescribe medications such as anti-depressants that can help her cope with this difficult time and/or refer her to therapy/counseling. You can remain supportive to her by encouraging her to become active in the community and share her feelings with you as a friend. If she has expressed thoughts of harming herself or others, it is really important that you give her the Mobile Crisis phone number: 946-9109 and consider calling the number if she won’t phone herself. The website www.canmat.org and self-help books such as Mind Over Mood and Feeling Good are useful references you can pass on to her for learning about this type of problems.

Relatively mild anxiety states in reaction to life circumstances are often time-limited, and many people respond to anxiety management strategies without medication. Support, problem-solving and relaxation techniques often help as the environmental crisis resolves. However, specific anxiety or mood disorders may develop from the original reaction. One should control caffeine or other stimulant use, minimize alcohol use (often used to control anxiety), reduce the use of short-acting tranquilizers (eg Valium and Ativan), and take steps to reduce stress including relaxation training and time management. More specific therapy/counselling and referral to a psychiatrist may be necessary if there is little improvement after several months of adequate medication therapy. Clicking on the title "Holiday Health" should link you to the information resource "Coping with Stress" [http://www.cmha.ca/data/1/rec_docs/403_CMHA_coping_with_stress_EN.pdf] by the Canadian Mental Health Association (www.cmha.ca).

I have high cholesterol, and my doctor warned me to stay away from fat. What can I do, especially during the Christmastime?

Having high cholesterol levels in your blood (dyslipidemia) is important, not because you can feel it directly, but because it is associated with a higher risk of cardiovascular disease (CVD; heart attacks and stroke). This is because excess fat deposits in the blood vessels throughout your body (atherosclerosis, AS), which can make it difficult for the heart to pump the blood (with the oxygen it carries) to the tissues that need it. Eventually, the arteries can block up completely, which can cause the tissues that are not getting the blood/oxygen to die (a “heart attack” results from a blockage of the arteries that feed the heart muscle; a stroke from a blockage of the arteries that feed the different areas of the brain). Dyslipidemia, diabetes, overweight, abdominal obesity (overweight in the tummy area), high blood pressure, and low cardio-respiratory fitness are primary risk factors for CVD. You are also at a higher risk if you have a strong family history of heart attacks/stroke or smoke. There are different types of cholesterols and different types of high cholesterol problems; some are genetic (run in the family), and others due to conditions such as hypothyroidism, pregnancy, excess weight, alcohol excess, certain liver and kidney diseases, and medications such as corticosteroids, hormone replacement therapy/oral contraceptives, and some blood pressure and heart medications.

Triglycerides are a type of fat that can be high from certain fats in the diet, but also extra sugars in the blood (excess starches like white breads, alcohol, sugared beverages) that your body turns into triglycerides. Niacin and fibrates help decrease mainly this type of fat.

LDL's (low-density lipoproteins) are the "bad cholesterols--you want them to be low. The “statin” drugs commonly target these fats by helping to lower the amount in your blood, but if you are on one, make sure to check in with your doctor regularly to monitor your liver and muscle enzyme level in your blood, which can go up with this class of drugs. “Resins” are another type of drug that lower LDL and can increase HDLs.

HDL's (high-density lipoproteins) are the good cholesterols that you want high, as they have a protective effect against heart disease + stroke. Regular exercise has been shown to boost this good cholesterol in the blood. Niacin and fibrates can increase this type.

In general, it is important to follow your doctor’s advice about your cholesterol problem, but diet, aimed at reducing blood cholesterol levels and weight (if needed) should always be the first approach. CVD can be reduced by eating less saturated and trans fats, less salt and sufficient amounts of fruit, vegetables and omega-3 and omega-6 polyunsaturated fats. Risk is also reduced with weight control and physical activity. A dietician is usually recommended to reach these goals:
- decrease dietary cholesterol intake to < 300 mg/day (<200 mg/d if AS already a problem): raises blood cholesterol levels but no significant association found yet between CVD and egg consumption (egg yolks—leche flan, dairy products, meat and shellfish)
- restrict fat intake to 30% of calories (20% if AS);
- fat distribution goals as a % of total energy:
o < 10%: Saturated fats tend to raise total & LDL cholesterol levels & are associated with increased risk of CVD: processed foods, coconut oil, lard, hydrogenated hard margarines, butter, full-fat dairy products and fatty meats—so avoid/cut down! Lechon is a big culprit because it is animal fat deep fried in fat—often animal. Yikes!
o < 1%: Trans fats elevate LDL and decrease HDL: partially hydrogenated margarines & shortenings, deep fried foods, processed foods made with partially hydrogenated fats and baked goods—AVOID
o 5-8%: Omega-6 polyunsaturated fats are the most effective replacement for saturated fats to improve heart disease outcomes: soybean, sunflower, safflower, corn and cottonseed oils
o 1-2%: Omega-3 polyunsaturated fats have good effects and decrease fatal CVD: fatty fish (tuna, salmon, mackerel, sea bass, fish oils), plant sources (canola, soybean, flaxseed oils, soft non-hydrogenated margarines, nuts, tofu, ground flaxseed)
o By difference to achieve a total fat intake of 15-30%: Monounsaturated fatty acids lower total & LDL cholesterol levels when substituted for saturated fats but not as well as polyunsaturated fats: canola, olive oils, nuts
- favour high-fibre intake
- limit simple sugars to 8% of total calories
- limit alcohol consumption to 5% of total calories

Plant sterols: the cholesterol-lowering effects have been well documented: vegetable oils, nuts, sesame & sunflower seeds, soy & other legumes.

Other nutrients: fruit and vegetables contribute to heart health through fibre, vitamins, minerals and phytonutrients (esp green leafy & cruciferous veggies, legumes & berries).
Also, if you can increase your fiber intake (10-15 g/d of soluble fiber—eg psyllium, oat bran, kidney beans, artichokes, dried prunes) not only will this help combat constipation which is common with fattening foods and lack of exercise common during Christmastime, but it also may lower cholesterol levels by an additional 10-15%. Pretty good deal! Although some studies suggest a protective role of antioxidants (vitamin E in nuts, seeds, some soft, non-hydrogenated margarines; vitamin C in citrus fruit, berries, tomatoes, potatoes, broccoli, cauliflower, kale, cabbage, sweet peppers; carotenoids/beta-carotene in carrots & tomatoes), controlled studies have not shown much proof. Sodium intake is directly associated with blood pressure, so limit it (salt added to foods, sodium in processed foods & additives like MSG)! Potassium (fruit and vegetables) helps lower blood pressure.

So in summary:
- Avoid hydrogenated oils and fats--Opt for low fat options on the labels of foods you buy.
- Limit the intake of fat from dairy and meat sources; Hidden fats you can cut down on: Whole or 2% milk—go for skim instead.
- Use appropriate vegetable oils in small amounts.
- Ensure a regular intake of fish (1-2 times per week) or plant sources of omega-3 fatty acids.
- Choose foods prepared without frying.
- Eat 400-500 g (6-8 servings) of fruit and vegetables daily.
- Restrict daily salt intake to less than 5 g.
- Choose fibre-rich whole grain cereals, as well as fruits and vegetables.

Increased physical activity may help decrease cholesterol and triglyceride levels while increasing HDL. Try to get regular physical activity/aerobic activity, decrease/stop smoking, watch extra sugars and salts in your foods, and try not to get too stressed during Christmastime! If you overdo it during the holidays, it might be a good idea to discuss this with your doctor to check where your cholesterol levels are at so you can modify your plan to better suit your lifestyle.

Have a healthy and relaxing Christmas! Maligayang Pasko at Masaganang Bagong Taon!

Stress Incontinence & Travel Health

FJ Vol 20, No 22
Nov 17-30/06

My lola has been complaining of leaking ihi when she coughs, laughs, or sneezes. She is too embarrassed to see the doctor. Why is this happening, and what can she do?

Stress incontinence (the loss of urine due to an increase in pressure in the tummy) is more common in women. Weakness in the pelvis muscles (eg due to childbirth, abdominal obesity--overweight in the tummy) and thinning of the bladder and vaginal muscles and tissues from the decrease in estrogen after menopause are often contributing factors. Urge incontinence is leakage due to inability to delay peeing when an urge is felt. Causes include bladder wall hyperactivity and neurological disorders such as Parkinson’s Disease and stroke. Overflow incontinence involves leakage due to an over-distended bladder usually from blocked urine outlet (eg. enlarged prostate) or neurological causes (eg. multiple sclerosis, diabetes affecting the nerves). Functional incontinence is caused by the inability to get to a toilet such as due to physical constraints (eg restricted mobility), mental factors (eg. dementia, depression), and environmental barriers (eg. distance to toilet, positioning).

Her doctor should rule out problems like a urinary tract infection or a problem with the nerves controlling the bladder muscles. Some things she can do include: decreasing caffeine intake; addressing any bowel problems like constipation; limiting fluid intake—1.5-2 L/d is considered appropriate; losing weight; quitting smoking; watching high-impact physical activities; avoiding some types of medications (check with her doctor) like diuretics, some blood pressure and depression drugs, and alcohol; and improving mobility & accessibility to toilets. When secondary causes have been ruled out or treated, she can try pelvic floor muscle training (aka Kegels): do a minimum of 30-45 pelvic floor muscle contractions (goal of 10 seconds for each contraction); done in 2 or 3 sets; may take 6-8 weeks to see results. To contract the pelvic floor muscle, instruct her to pee, and while she’s peeing, she should squeeze her pelvic muscles to stop the flow of pee. Biofeedback and/or electrical stimulation therapy can teach her to isolate and control these muscles if she is not having any luck. If the problem is severe, her doc might refer her to a gynecologist/urologist who could confirm the diagnosis + possibly book her for surgery. Another option is wearing pads/ “Depends” to catch the leak. Depending on the cause, there are some medications her doctor can prescribe to help manage her symptoms. There are different treatments available for men who have difficulty with stress incontinence after having prostate surgery—check with their urologist.

My family is going to the Philippines for Christmas. What do we need to do ahead of time?

According to the Health Canada (http://www.hc-sc.gc.ca/iyh-vsv/life-vie/travel-voyage_e.html) and WRHA websites (http://www.wrha.mb.ca/community/travel/manual_countries.php), Canadians traveling internationally should contact their doctor or a travel clinic 6-8 weeks before traveling, regardless of where they are going, to have their risk assessed. Based on your current health, travel itinerary and previous immunization history, your doctor can determine what immunizations and/or preventive medication you may need, as well as advise you on how you can avoid disease risks.

By far the most common complaint while traveling is diarrhea. This is usually caused by the differences in water purity. Travelers may have diarrhea if they drink the local water or food prepared with local water in these countries.
You can also be at risk for a number of childhood illnesses (Diphtheria, Tetanus, Polio, Measles, Mumps, Rubella) when you travel, especially if you have not been immunized against them or haven’t kept your immunizations up to date. In countries where sanitary conditions are poor, immunizations may be recommended—there is a higher risk of hepatitis A (immunization recommended for all travelers) and typhoid in the Philippines. Depending on your travel activities and the local disease situation, you may need to be immunized against Meningitis, Japanese encephalitis (depending on degree of exposure), European tick-borne encephalitis, Hepatitis B (higher risk), Rabies (higher risk). Depending on where you are traveling, you may also be at risk of Malaria (caused by infected mosquito bites in many tropical countries; rural areas only, except no risk in Manila and province of Bohol, Catanduanes and Cebu), Yellow fever (caused by infected mosquito bites in Central Africa and South America; if traveling from an endemic zone and > 1 yr of age), Dengue fever (caused by infected mosquito bites in many tropical countries), Schistosomiasis (caused by a parasite in fresh water in the Carribean, South America, Africa, the Middle East and Southeast Asia). You are also at a higher risk of tuberculosis that is resistant to many drugs we use to treat it. As well, some sexually transmitted diseases, such as HIV/AIDS, are more common in some countries than they are in Canada.

You should also be safety conscious when traveling. Economic conditions in developing countries can cause increased crime rates and tourists are often targeted.
Some tips to help you enjoy safe travel:
_. Make sure all your regular vaccinations are up to date.
_. Before you travel, contact a travel clinic or your doctor six to eight weeks before you go, to allow time for any vaccinations you may need. This is especially true if you are going to tropical areas or developing countries.
_. Arrange for private health insurance while you are away, as your provincial/territorial health insurance may not cover you. Your travel agent can advise you on this.
_. If you are going to an area where malaria is present, it is important that you take anti-malarial medication as prescribed by your doctor.
_. Since anti-malarial medication does not guarantee absolute protection against the disease, preventing mosquito bites is very important. Use mosquito repellents when outside, especially between dusk and dawn. Sleep in well-screened or air conditioned accommodation or use a bed net. Wear trousers and long sleeves at dusk.
_. If you become ill in the first two months to a year after you return, see your doctor immediately and tell her/him that you have visited an area where malaria occurs.
_. To prevent diarrhea, the key principles to remember are: boil it, cook it, peel it or leave it! Always drink purified water or commercially bottled beverages, and pasteurized milk. Avoid ice, salads, re-heated foods, uncooked shellfish, fruit that is not peeled and food from street vendors.
_. Wash your hands often with soap or a sanitizing agent when travelling, especially before eating or drinking.
_. Should you experience diarrhea, be sure to drink plenty of liquids to prevent becoming dehydrated, especially in warm climates.
_. In warmer climates, always use a sunblock with a minimum SPF of 15.
_. To help prevent sexually transmitted diseases, always use a condom if you have sex with someone you meet while travelling.
_. Never share needles to inject intravenous drugs with anyone.
_. Swim in fresh water only if you know it is free of biharzia, the parasites that cause schistosomiasis.
_. Do not walk alone in remote areas, back streets or beaches, where you may be at risk of a personal attack or bag snatching. Valuables should be left at home or deposited in hotel safes. Travellers cheques, cash, passports and tickets should not be carried in bags that can be snatched. It is recommended that you use a body belt.
_. Do not ride in over-crowded vehicles or on motorcycles, especially at night outside of urban areas.
_. If you need medication for an existing medical condition, take enough with you to last during your travel. Make sure the containers are clearly marked and carry a copy of the doctor's prescription with you. Essential medication should be carried in two different pieces of luggage, in case one should get lost or stolen.
_. If your medication requires sterile syringes or needles, carry a doctor's explanation or medical certificate with you. In many countries where drug trafficking is a problem, a traveller found with syringes and without adequate explanation, could be in serious trouble with the police.

Ask Dr. Denise: Gout & STD screening

The Filipino Journal: October 20-November 5 2006 issue; Volume 20, Number 20 p 10
By Denise Koh, BSc (mcl), MD, CCFP

* My dad suffers from gout. What is it, and what can he do to treat it?

Gout is a disease in which uric acid (UA, the normal end product of the breakdown of purines) crystals deposit in body tissues. This causes recurrent attacks of severe joint pain and inflammation, deposits in soft tissues, kidney problems, and kidney stones. Many genetic and environmental factors affect the chain of events that regulate UA formation, transport, and disposal. Any problem in these processes can lead to too much UA in the blood and gout. Filipinos have a predisposition to gout. There is a higher blood level seen in Filipinos living in North America compared with Filipinos living in the Philippines. Filipinos have a limited ability to excrete/remove UA leading to a tendency to high blood UA levels manifested when a diet with a relatively high purine content, such as the usual North American diet, is eaten. Your dad can do several things to control his disease: lose weight, avoid foods high in purines, avoid alcohol (increases production and impairs removal of UA), avoid dehydration (drink lots of water!), and avoid diuretics (“water pills” often used for high blood pressure) if possible. High purine foods include visceral (organ) meats (liver, tripe), sardines, shellfish, turkey, salmon, trout, beans, peas, asparagus, and spinach.


* I have a new sexual partner and was told to get checked for STD’s, even though I feel fine. What is involved in an STD screen, and when should someone get checked?

A common misperception is that no symptoms, means no STI (sexually-transmitted infections). This is far from the truth, and is a huge reason for the continued spread of STIs. Get tested when: you have unprotected (no condom) sex, you have a new partner, you are worried about it, you are experiencing any symptoms such as discharge, pelvic pain/burning, lumps, bumps, sores, unusual vaginal bleeding, or fertility concerns. Many people choose to get tested regularly, such as every 6 months, or with their annual physical exam. A typical screen can include blood tests for HIV (anonymous and requires your consent), Hepatitis B, Syphilis, and Herpes Simplex (although some docs don’t check for herpes because it is so common, and can’t be cured). Gonorrhea and Chlamydia can be checked in two ways: 1) a pee test or 2) a swab. For women, this is a swab of the inside of the cervix (opening of the uterus) requiring the insertion of a speculum typically used in Pap tests. For men, this requires a swab of the urethra/inside the penis. If you are uncomfortable with the swab tests, you can get the pee test instead, keeping in mind that these tests are not as sensitive as the swabs. It’s way better to get tested than not—for treatment and relief from easily treatable infections, management with improved outcome of the non-curable ones, prevention of spread, and peace of mind. Tests for Genital Warts are more specialized and seldom performed (extremely common and difficult to treat), but often a doctor can recognize them on examination. Tests for vaginal infections (not necessarily sexually-transmitted) such as yeast, trichomonas, and bacterial vaginosis are usually reserved for women with symptoms.

Ask Dr. Denise: Workplace Safety and Health (part 2)

The Filipino Journal: September 18-October 5 2006 issue p 6

My boss is asking me to work in what I consider unsafe conditions. What can I do?
What are the safety and health rights and responsibilities in the workplace?

When it comes to safety and health, every worker in Manitoba, regardless of age, has 3 basic rights in the workplace:
- The right to know about what hazards there are in the workplace and what precautions must be taken to prevent injuries from these hazards.
- The right to participate in safety and health activities in the workplace without fear of any form of discriminatory action such as discipline.
- The right to refuse unsafe work.

In Manitoba, health and safety rights are guaranteed by the Workplace Safety and Health Act and the Canada Labour Code. Most workers are under provincial authority and are protected by the Workplace Safety and Health Act. The Workers Compensation Act was created to promote healthy, safe workplaces, to encourage safe, timely return to work and to provide insured benefits to workers who get injured on the job. In addition to the laws, every workplace should have its own safety policy, procedures and safe operating practices.

Your employer is legally responsible for putting safe work practices in place, and you’re responsible for following them. If you have safety and health concerns, it’s your responsibility to report them. If a task feels unsafe, tell your immediate supervisor, and explain why you’re not comfortable. If you don’t get a satisfactory answer or s/he isn’t available, go to her/his supervisor. If you’re still not satisfied, ask your safety representative, a member of the safety committee, or a shop steward. Your last resort is the Workplace Safety and Health Division (WSH) or Human Resources and Skills Development Canada (HRSDC). WSH Officers have the power and duties to inspect any workplace, investigate any potential hazards situation and work refusal; and order compliance with the law (eg the Act or Regulations).

Manitoba’s employment standards laws (as outlined in The Employment Standards Code) promote fairness in the workplace for both employees and employers. The Employment Standards Branch is a neutral party that administers laws on minimum wages, hours of work, holidays and other workplace benefits. It is also responsible for investigating complaints of violations of these laws. Most employees in Manitoba fall under this code. Independent contractors (self-employed) are not covered. Some parts of the Code do not apply to agricultural workers, sitters, professionals, part-time domestic workers, Crown employees, family members employed in a family business, temporary election workers and some others.

If you have questions about WSH, visit the Workplace Safety and Health Division website at www.gov.mb.ca/labour/safety. Call the WSHD Client Services office at 945-3446 or 1-800-282-8069. This is the part of the provincial government that promotes and enforces workplace safety and health (law). They can answer your questions or concerns or provide you with information confidentially. If a serious incident, death or other problem is occurring in your workplace, they will send a workplace safety and health officer to your workplace.

The Human Resources and Skills Development Canada (HRSDC) – Labour Program is responsible for federally regulated workplaces such as national railways, grain elevators, inter-provincial trucking/transportation, communications, banks, etc). Call the HRDC – Labour Program at 983-6375. If you live outside Winnipeg, call 1-800-838-2033 or visit the website at www.hrdc-drhc.gc.ca.

The MFL Occupational Health Centre (phone 949-0811 or 1-888-843-1229, www.mflohc.mb.ca) is a community health centre specializing in work-related injuries and diseases. It is a non-profit, charitable organization funded by the Winnipeg Regional Health Authority and by donations from individuals, and unions. Its doctors are specialists in occupational medicine; referrals are not required. The Centre organizes public presentations and offers hands-on workshops tailored to your needs. One of its special initiatives is an Immigrant Workers Education and Outreach Project. It has a library with over 40 fact sheets on workplace health and safety issues such as ergonomics, shift work, work stress, and workplace chemicals. Some are available in Tagalog.


Some interesting facts:

- 40% of all injuries suffered by workers throughout their careers happen in the 1st 6 months on the job.
- 1/3 of all workplace injuries happen to those 15-24 years of age.
- Top 5 injuries in this group:
o Sprains, strains and tears
o Open wounds
o Surface wounds and bruises
o Other traumatic injuries and disorders
o Fractures and dislocations
- Top 5 Causes of injury to young workers:
o Struck by object
o Over exertion
o Bodily reaction (3eg jerking motion)
o Struck against object
o Caught in objects
- Top 5 body parts injured in young workers: hand/fingers/lower back/ eyes/ lower arm/ lower leg

Ask Dr. Denise: Workplace Safety and Health

The Filipino Journal: August 18-September 5 2006 issue p 6

I hurt my back at work today lifting patients (I'm a nurse). What should I do?

If you get hurt or sick because of your job you need to:
1) Get medical attention as soon as possible. Be sure to let your healthcare provider know you were injured or got ill at work. S/he should fill out a WCB Healthcare Report and fax/mail it to the WCB.
2) Tell your supervisor about any injury or illness as soon as possible after it happens. Ask your employer if they have a modified return-to-work program you could get involved in while you are recovering. Your employer has a responsibility to report workplace injuries to the WCB as soon as possible after learning of the injury (within 5 working days). Your employer must also pay you for the full day of the day you were hurt at work, not just up to the time of your injury.
3) If you miss time from work because of the injury, check with your employer whether you are covered by the Workers Compensation Board of Manitoba (WCB). If so, report the accident or illness to the WCB as soon as possible (954-4100; toll-free 1-800-362-3340 between 8 am – 7 pm Monday to Friday).You will be given a claim number and contact info of an adjudicator who will handle your claim. If you have to pay for any medication or other expenses related to your injury, keep your original receipts and advise your Adjudicator. These expenses may be covered by the WCB. WCB will ensure the injury occurred as a result of your employment and confirm the extent of your injury with your HCP, determine your benefit entitlement, and contact you to let you know what the decision is on your claim and if/when you can expect to receive benefits and services. Check out www.wcb.mb.ca for more information.
4) Follow your doctor/HCP’s treatment plan and attend any follow up appointments. It is important for you to get better and go back to work as soon as you are able. WCB benefits can be reduced or stopped if you are not doing what you can to get better.
5) Stay in touch with your employer on a regular basis to ensure they are aware of your recovery progress and when you may be able to return to modified/alternate work or your regular job duties. Stay in touch with your Adjudicator to ensure s/he is aware of any relevant changes with respect to your injury, recovery, and ability to return to your regular job.

In general, if you’ve strained your back, try a hot bath or shower followed by stretching exercises. Gradually increase your walking distance. While progressing with your stretching exercises and your walking distance, gradually introduce strengthening exercises. If you are overweight, consider changing your eating and exercise habits, as excess body weight places additional strain on the spine. Most back injuries resolve quickly with time and simple treatment. A good posture while standing, sitting and sleeping helps maintain a healthy back. Stay fit, and avoid overeating. Exercise helps to prevent back injury and also speeds recovery. Gentle exercise after a back injury is essential to recovery. Keep a positive attitude. When lifting or carrying even light objects, remember to:
- place your feet shoulder-width apart for good balance
- bend your knees and do not bend over to lift
- keep the load close to the centre of your body
- lightly “tense” your trunk muscles before and during lifting
- lift gradually and smoothly, without jerking, keeping your back straight
- pivot with your feet, don’t twist your back while lifting
- coordinate your lift when working with a partner

The Filipino Divide (8/17/06)

Ako ay Pilipina, indeed.

That is the stinging concluding remark from a letter to the editor in response to my proud self-statement (a reference to the song Magdaragat introduced me to which eventually connected me to my heritage) in my FJ article on Folklorama when I first moved to Winnipeg in 2003. Ar-ouch. To this day, during Folklorama 3 years later, I can feel my blood pressure rise and my heart sink when I recall the experience. The writer was not happy with my use of the word “Flip” to refer to Filipinos, apparently considered derogatory by some. I was shocked at the strong negative reaction and attack at not only my character but also my definition of myself as a Filipina—ang bilis bilis, too!--because all my life, that word was a special term, almost of entitlement—like my “peeps”, my “homies.” This was the term my barcadas, a handful of Saskatchewan Filipino-Canadian teens—The Filipinas Youth Group, used to call ourselves—we were cool because we had something no one else did. Like a mini-gang minus the drugs and guns and scare factor. We wore bandannas and break-danced like no other. Heck, we dominated in the dance realm. I don’t know where Bagets (form of dance Magdaragat taught us) originally came from, but it became ours. We serenaded and pen-pal’ed like it was going out of style. We kicked butt in basketball and sikaran. No one could touch us. Looking back, it was par for the course; identity issues--what all teens go through.

Now 20 years later, that letter triggered another mini identity crisis—I was seeking any reassurance I could get from my parents and the FJ editors. Did I just offend the entire Filipino community with my words?? Was I any less Filipino because that word was power where I came from but here—not so much? And why didn’t anyone teach me this in Coconut School??! What about my lack of Tagalog? Or my Chinese blood and Chinese name? What do I do to fix this?? Dare I ask the question--who’s “more Filipino” here: someone who tries to build up the Filipino spirit in all its different forms despite glaring un-Filipino-ness, or someone with the privilege of breeding & birthright who tries to break it? I think I’d take 10 puti in barongg tagalogs singing our anthem off-key over 1 purebred Pinoy holding a gun to another. But that’s just “You’re-not-Filipino…No-you’re-not”–me. I still ask random Pinoys I meet about that word, because I do not want to give up that word; I refuse to give up that pride I’ve associated with it.

I recently went to see Filipino-Canadian comic Ron Josol at Rumour’s Comedy club, and absolutely loved the show. I couldn’t help but laugh along with the largely Filipino crowd at his hilarious jokes about such “Pinoy-isms” as Philippine phonetics (“what’s his pahkking frovlem??”) and the Filipino propensity for choosing nursing as a career. What about the Philippine nanny? Who can deny this stereotype? And is it wrong to laugh at its existence and ourselves as a result? When does laughing at ourselves become harmful and the perpetuation of damaging prejudices? Conversely, when does racial sensitivity and political correctness stunt individual interpretation and expression of culture? Call a spade a spade…but then we’ve gotta look at the definition of excavation implements, the national standards of yard care tools, and if it heard the tree falling in the forest. Naman.

Living here in Winnipeg, I see Filipinos excelling in all sorts of careers, occupations, and work-settings. Certainly, in my medical training and practice, I get to work with a good number of Filipino nurses/health care workers in a variety of settings, both as patients and colleagues. Having just finished my Occupational Medicine rotation for my Community Medicine residency, I’ve gotten the chance to witness Filipinos and their health in the workplace at many different levels—a scope of the Filipino-Canadian experience…from Immigrant to Canadian-born, from caregiver to patient, from teacher to student. We are a vast and varied bunch, a spectrum: brown Filipinos, yellow Filipinos, white Filipinos, Filipino-whites, mestizas/zos, blue, orange, green, and purple Filipinos…you name it. I’ve had in-depth discussions with many Filipinos from all over this rainbow of backgrounds on this collective experience, what I call the Filipino Divide. The “ignorant coconut youth disconnected from their roots” vs the “old guards enmeshed in obsolete thinking” and everything in between. Yes, the words are there on purpose; they’re there to inflame. Why? Because if we don’t acknowledge their existence, we can’t get on top of these problems to work on the root cause. Sometimes the words have to slap us upside the head to get us to see what message lies beneath.

According to the HRSDC website, in 2001:
Filipinos in Canada represented the fourth largest visible minority subgroup (7.7% of total visible minority population; 1% of the total population). Toronto, Vancouver and Winnipeg accounted for 72% of the Filipino population…Filipinos were a very young group. Only 6% of their total population was 65 and over (compared with 13% of the non-visible minority population; 7% of the overall visible minority population). Close to 50% of the total Filipino population were of prime working age (25-54)…Filipinos had a high level of education. Among all visible minority subgroups, they ranked second in terms of the proportion of the population 15 years and over having earned a bachelor’s degree or higher and ranked first in terms of the percentage of the population with more than grade 13…Approximately 31% of Filipinos 15 years and over had a bachelor’s degree or higher compared to only 14% of the non-visible minority population and 24% of the overall visible minority population. In contrast to most of the other visible minority subgroups, a larger percentage of Filipino women than men had earned a university degree (33% vs. 27%)…The most popular fields of study were Commerce Management & Business Administration (27%), Health Professions Sciences & Technologies (22%), Engineering & Applied Sciences Technologies & Trades (13%) and Engineering & Applied Sciences (10%). These four fields made up 72% of the Filipino population that went beyond secondary school education to achieve a degree, certificate or diploma. They represented 1.2% of the total workforce and 9.1% of the overall visible minority workforce…Filipinos were most frequently working in the following Employment Equity Occupational Groups (EEOGs): Intermediate Sales & Service Personnel (19%), Other Sales & Service Personnel (14%), Clerical Personnel (13%) and Semi Skilled Manual Workers (13%)… Filipinos had the highest participation rate and the lowest unemployment rate among all visible minority subgroups. Their participation rate (76%) was considerably higher than that of the non-visible minority population (66.5%). Their unemployment rate was exceptionally low (5.6%) compared to that of the non-visible minority population (7.1%).
This is all good, right? But…
…In spite of their high level of education, the proportion of Filipinos in Professional occupations (12%) was below that observed for both the nonvisible minority population (15%) and the overall visible minority population (17%)…In 2000, Filipinos had the second lowest average income among all visible minority subgroups for full-time, full-year employment. Their income, at $32,748, was equivalent to only 74% of what the non-visible minority population earned ($43,989) and 86% of what total visible minorities earned ($37,957). Filipino women earned 81% of what Filipino men earned.

Okay. I have a huge problem with this. This bothers me to no end. In fact, it sucks big fat greasy lechon. But I am not at all surprised.

I have heard horror stories about the hell Filipino nannies have gone through—not just in Canada but world-wide. They have been abused and raped. The egregious acts done to them in Canada--inconceivable. But true. This is a problem.

I know of a Canadian nurse who worked in the Middle East along-side nurses from all over the world. There was a pay differential among these nurses depending on the country of origin—Filipino nurses being almost at the bottom, North American nurses at the top of the pay scale. So this “top-level” nurse would take the shifts, and if she wanted to take a day off, would get a Filipino nurse or one lower in pay level to take the shift, and she would pocket the difference. Pretty smart Canadian, eh? Of course she was. I wouldn’t blame her. Sure, there was discussion about the lower paid nurses’ countries getting larger grants for their nurses at the government level, and somehow this ‘makes up for the inequity.’ Either way, to me, this is a problem.

I know how dirt-cheap things are in the Philippines—from wares to people and services. $15 for a luxury treatment at a spa vs $80 and up for the same thing here. Don’t think I didn’t take advantage of this—shopping maven that I am. But is this a problem? You bet your shiny new sapatos I just gave you ($3; 2 for $5!) it is.

I have heard accusations and terms such as “corruption” (a touchy buzzword to our kababayyan) in reference to Filipinos who have benefited financially or otherwise in their work—be it facilitation of new immigrants into our community, leading and representing us on a political front, in health care, religious circles, volunteering for the community functions, etc, etc, etc. To the point where some work almost ragged for way less than is fair just to uphold that perception of giving. I come from a family that ascribes to this, so I know. I bet we all do. There is great satisfaction giving something for nothing. But that doesn’t put rice on the table. Again, this is a real big problem.

This divide is in our thinking and in our belief structure. I witness it all the time. What strikes me is this impressive work ethic that transcends all the fields we work in—we take pride in what we do, and we care. Deeply. We are brought up to give and give and give. Give more. Care more. Do and be more. There is nothing to be ashamed about that. Our journals applaud these acts and rightly so. I think we don’t even do this enough. But we are also brought up to be humble and modest, painfully so. If we take in return, this is considered rude and bad--bastos. Somewhere along the line giving all and accepting so little in return became the Philippine way. But this translates into the lowest paid workers, despite definite measurable contribution and awards of excellence in our work. This translates into burnout and loss of the very people trying to make a positive difference. This translates into poorer health in our people and the community as a whole. This translates into Pinoy tearing down Pinoy because of the harmful misguided mentality that one has to lose if another wins rather than a Win/Win or No Deal approach. This divide breaks my heart and my spirit, more than words can ever capture. This must be addressed. We need to build.

When I hear the accent and see the familiar mannerisms I grew up with, I always get a nostalgic twinge of what I call “home”: a deep sense of kinship, belonging, and identity. The pointing with the lips, the wordless eyebrow greetings. The expectation of any stranger for a full plate of food at a Filipino BBQ, and the chastising of any Filipino host who doesn’t represent our hospitality. The respectful greeting of elders with hand to forehead, kneeling. All of it. For some trying to assimilate into North American culture, these things are embarrassing and funny. For me, these things strike an emotional chord—I can relate to these “quirks”, their irrational rationale, their oddness to an on-looker, but there is this intense pride mixed with a sadness in what they represent: the unsurpassable good in our hearts mixed with this dooming self-perception of inferiority and submissiveness. This chord and the divide it represents are rooted deep in my being, and I am only now beginning to understand it. It’s mine.

So I will say it again, and this time with a vengeance: Ako ay Pilipina. Ako ay Flip. I am Pyllifinah. Whatever way I say it, you cannot take that away from me. You can call me a “dirty Flip” any day, and, frankly, I’d love you that much more for it.

Ask Dr. Denise: Accessing Medical Care

exerpts published in The Filipino Journal: July 5-20 2006 issue p 19

Kumusta ka and thank you for your queries, support, and good wishes! Thank you also for challenging me to do a quick tutorial in Tagalog—there’s no better way to learn than diving right in! I must however, mention that as I am still learning our native tongue, I am unable to fully address your questions if posed in Tagalog, and because I must protect your health information, I can’t simply forward your letters to translators. If at all possible, please send me your questions/comments in English, and if you’d like a tagalog translation, I can attempt to do that. I really value your questions/comments, and will do my best to help out in as timely a fashion as I am able. Please keep in mind that due to the nature of this forum (my limited ability to gather a medical history or perform physical examinations or laboratory tests) and from a medico-legal perspective, I can’t offer explicit individual medical advice nor provide any type of follow-up care. I cannot take the role of a reader's physician or health care provider. All I can do is provide general health education with the intent of having this health information accessible to the Filipino Journal's readers. My plan is to incorporate my responses in this column, along with your medical questions. Please indicate precisely if/how you would like your question published. I do not plan to identify you or anyone you've inquired about in the column unless you specifically request this and I have received written consent from the involved individuals. Depending on the volume of readers' questions I receive, I may need to prioritize my responses in the journal (leave some questions for future issues) and categorize types of questions for summarizing my responses. Salamat po—thank you for your patience and understanding. Here are a couple excellent questions that have come up:

- I just immigrated to Canada. I need a doctor, preferably Filipino/Filipina. How do I get one?


Finding a family physician here is difficult, and finding a Pinoy one is even tougher. I don’t know of any Filipino doctors right now accepting patients, but I’m looking into compiling a list. Your best bet is to contact:
The Family Doctor Connection at (204) 786-7111. The Manitoba College of Family Physicians and Manitoba Health will give you an up-to-date list of Winnipeg family doctors accepting new patients.

- Our daughter has been feeling quite ill, throwing up and headaches. When should we take her to see a doctor?


If you have an urgent medical concern, please contact your doctor or health care provider, if possible. On Page 08 of the Health Services Directory (dark blue pages in the middle of the MTS Winnipeg White Pages, there are Emergency Room Tips and the contact information for the Emergency Departments. The Urgent Care Centre (Misericordia Health Centre) and Pan Am Minor Injury Clinic are good places to consider for non-emergent/less urgent problems. You can also try one of the walk-in clinics in your area. It is always helpful to call ahead of time, if possible, to coordinate your care.

If you are unsure if you need medical care and/or are unable to contact your doctor, you can call Health Links-Info Sante at (204) 788-8200; Toll-free 1-888-315-9257 where registered nurses can answer your health-related questions and direct you in more detail.

If your question is specifically regarding a medication/drug you are taking, you can contact your dispensing pharmacist for details on the medications.

For Mental Health concerns (such as for depression, anxiety, etc): you can call the WRHA Mobile Crisis Service at (204) 946-9109 where hospital emergency rooms and the Urgent Care Centre provide some mental health crisis services. KLINIC has a 24-hour Crisis/Suicide Line at (204) 786-8686; Toll-free 1-888-322-3019; Deaf Access (204) 784-4097; Counselling Appointments at (204) 784-4059; Drop-in Counselling call (204) 784-4067.

The 24-hour Sexual Assault Crisis Line is (204) 786-8631; Toll-free 1-888-292-7565; Deaf Access (204) 784-4097; Counselling Appointments at (204) 784-4059; Drop-in Counselling call (204) 784-4067.

Health Emergency/Ambulance call 911.
For the Poison Helpline call (204) 787-2591.

A couple of useful websites:
The Winnipeg Regional Health Authority www.wrha.mb.ca; (204) 926-7000
Manitoba Health: www.gov.mb.ca/health

- My lola hasn't been to the doctor in years. She is scared to be examined by the doctor. What can she expect?

I encourage patients to be pro-active about their care, especially considering the current difficulties with access to physicians/medical care. If there are any parts of the doctor’s visit that you don’t understand, please feel free to ask your doctor. S/he should run through the procedure with you ahead of time, if you are fearful. Doctors also have the duty to keep personal health information confidential. Often the pap/gynecological/breast exams are the more worrisome to some women. Nothing is done w/o consent of the patient, so if it feels uncomfortable, don’t necessarily do it. A patient also has the right to request a helper. Many physicians automatically bring in a “helper”/witness because of the sensitive nature of the tests.

Ask Dr. Denise: Readers' health questions welcome

The Filipino Journal: Vol 20, No 11 p 25
June 4-20 2006 issue

Kumusta kayo, mga kababayan! It feels good to greet you in Tagalog. I’d like to introduce this column and myself. My name is Denise Marie Koh, and I am a physician here in Winnipeg. I was born in Regina, Saskatchewan of Filipino parents after they took up citizenship here in the 70s. Although my family has left the Philippines, the Philippines is still very much in us. Throughout my life, my family has always been actively involved with the Filipino community at many levels—in the social, religious, and creative/artistic spheres, to name a few. From a young age, I have continually been encouraged to be proactive and speak out on issues close to home. In Regina, as a Filipinas Youth Group Ambassador, I was involved with Philippine Folk dancing and the language school. When I moved to Winnipeg in 2003 to continue my medical training, my journey to understanding my roots kicked into high gear. Since my move, I’ve had an opportunity not only to plug into the culturally rich Filipino network and eat a lot more pancit, lumpia, and other goodies, but I have also gotten to work closely with many Filipinos. I got a good look at the health issues affecting our people, having seen and treated Filipino patients at the hospitals and outpatient clinics. I’ve noticed recurring themes in my medical practice, especially among the Filipino patient population. This was reinforced greatly by my medical mission to Catanduanes in January, 2005.

What an eye-opener. When the majority of the hundreds of patients I saw requested vitamins, I learned of a serious problem that makes my stomach turn. In this day and age, no one should suffer malnutrition. Ever. On top of limited essentials such as running water and electricity, I noticed a major lack of health care services and medications, and saw the problems inherent in this health care system, particularly compounded in rural areas. I learned only too well that the people who need the health resources the most in our and many communities, get the least by way of limited access, communication difficulties, and cultural barriers. This socio-cultural isolation is self-perpetuating—the perfect catch 22. I have seen certain illnesses and health issues that are common to our kababayan, and at the suggestions of some patients, I’d like to address those problems as a service to you. It is one of my life missions to educate and help Filipinos understand about their health and make a positive impact on their collective wellbeing. Simply put, I know I can help Filipinos lead a healthy and healthful lifestyle, and I am hoping to use this forum to do so. I plan to discuss such issues as gout, diabetes, sexual health, high blood pressure, high cholesterol, musculoskeletal injuries, drugs and alcohol, depression, nutritional supplements, common medications, and laboratory tests. A Q & A format would be most useful, and would ensure the column is tailored to what you, the readers, want. Despite my busy schedule, I am doing this with no expectation of remuneration (I'm not kidding, Tita Linda!). So please, feel free to ask me any health or medical questions—if I can’t answer you, I will find the right sources who can. Alagaan ninyo ang katawan at kalusugan ninyo! Take care, and mind your health!

written ~5/31/06

Paglalakbay sa Atin

February 14, 2005

I was a child when I last visited the Philippines twenty years ago. I have vague memories of the mass of people from the airport in Manila to Tita’s house. This time the crowd was not as dense but my cousin Joel Carlos who met us at the airport showed his skill in maneuvering through the noisy and nerve-racking traffic. The streets were alive with cars, jeepneys, tricycles, jaywalkers and peddlers.

A week before and after the mission, we stayed with Tita Lor (Lorinda Carlos) in Paranaque. She threw a party so I had a chance to meet my relatives. A few times we had sumptuous dinners at Tito Rody (Carlos) who lives two minutes away. We had king crabs, large prawns, mussels, bangus, pancit, lechon, etc. Considering the variety of tasty Philippine cuisine, I'm amazed at how the folks maintain their slender figures.

I am grateful to Tita Mimi (Salazar) who took us to Divisoria to buy Capiz goods and to Silahis International in Intramuros, to Ate Ninni (Castro) and Ate Maridee (Carlos) who took us to the megamalls. And what I didn’t get to buy, I got as presents: a crocheted bandana and sungka from Ate Bingle (Dr. Victoria Ascue), the naked man holding a barrel from Cousin Nikka (Carlos), pj and other fancy clothes from Tita Ofie (Carlos) and Tita Cora (Castro) who traveled with Tito Andy from Malolos, a mahjong set with numbered tiles from Tita Lor and various other gifts, too many to mention.

After the mission, I had a great time hanging out with the volunteers at the 5-star Westin Hotel. Later, Mom’s friends, Drs. Romeo and .Ernesta Quintana, brought us to their home in UP Los Banos for a couple of days during which we visited the International Rice Research Institute with Dr. Ben Vergara, one of nine living National Scientists of the Philippines and author of the Farmer’s Primer on Growing Rice. Forty eight editions have been published in 40 languages in more than 20 countries in Asia, Africa, and Latin America which substantially increased global rice production. The Vergaras treated us at the Kamayan sa Palaisdaan where we had a seafood dinner before dessert of kutsinta, puto bumbong, etc. at their magnificent home. Mrs. Lina Vergara showed us the sprawling electrified miniature Christmas village she built.

I gained so many great memories, new-found friendships, and special gifts I don’t know where to begin to thank all relatives and friends. Even on our return trip, my cousin Kuya Parrish Carlos got our seats upgraded to business class which included the use of the lounge, free drinks and more food: arroz caldo, finger food, fresh mangoes and other fruits and pastries.

This trip was a tremendous experience for me both professionally and culturally. The chance to meet and build bonds with my relatives was a big bonus. I’ll do it again if the golden opportunity presents itself.

The 5th Medical Mission to Catanduanes

February 14, 2005; published in The Filipino Journal

I looked up nervously at the thin, dark 89-year-old woman as she sat down across the table from me. I was still a medical resident; I approached this mission with eagerness and trepidation. This room was a bustle of frenzied activity—crowds of Filipinos outside in the island heat, pressed up against the door to our makeshift waiting room/examining room. About 25 of the docs, nurses, and other volunteers on this mission moved around the group of patients lucky enough to be admitted in, taking brief histories, blood pressures, examining them in their chairs, then directing them to the lab, pharmacy, or consultants elsewhere in this hospital. There were 2 makeshift exam booths in the corners—where a small hospital gurney was separated from the room with a small divider. It was hot, only a couple fans helping to dissipate the heat of all the people milling about in this room that only hours earlier served as church for our daily morning mass. Periodically a volunteer would come by with refreshments—empanadas, bottled water, pan de sal, hopia, juice, assorted Filipino pastries.

Anong sakit po? I attempted in Tagalog, as I scanned her sheet of vital signs. The interpreter translated for me. “Her back hurts.” How long? 3-4 years. I continued to take a history of her complaints which were similar to many of the others’ I’d see—dizziness, weakness, cough, various pains, persistent rashes, bowel complaints sprinkled with the odd tuberculosis, ulcer. Compared to back home in Winnipeg, I saw more unusual infectious diseases and less depression and anxiety. As I examined her, I noticed how spry and hardy the elderly were here compared to the overweight frail in North America. I realized that these people’s health issues were a reflection of the difficult circumstances: chronic malnutrition, inconsistent care, piecemeal investigations and treatments. Here, I knew that if someone was sitting in front of me, it was probably a lot worse than he/she was saying—these people didn’t seek medical attention unless absolutely necessary, shared and used costly medications sparingly over years, and were generally dictated by the price/access of treatments rather than their necessity. Once I realized that these people would likely not see a physician/health care professional for a long time and the treatments/medications I could give them now were essentially all they’d have access to for who knows how long, I let my own insecurities fall to the wayside and dived into the huge work ahead of me. In the interest of seeing as many patients as possible during my short time on this mission, I had less time to spend with each patient.

This mission, the 5th Medical, Surgical, and Dental Mission of the Catanduanes International Association, lasted from January 10-14th, 2005 in the town of Virac. We saw a total of 4892 patients from all 11 towns of the province of Catanduanes. 1146 more patients were registered but not seen for lack of time and resources. Mission volunteers from Canada, the United States and the Philippines registered 1283 patients on general consultations and another 1184 pediatric cases. The balance of the 4892 indigent patients who went to the Eastern Bicol Medical Center during the five-day mission are as follows: 187 Internal Medicine cases, 19 Obstetrics-Gynecology case, 93 Gastroenterology cases, 153 Ophthalmology cases, 310 Refraction cases, 58 Physical Therapy cases, 120 Minor Surgery cases, 76 Major Surgery cases, 500 Dental cases, and 909 Laboratory/X-ray cases. The medical mission, which also brought drugs and medicines, filled a total of 3084 prescriptions and gave vitamins to 168 patients and families. Of the 76 major surgeries, including cataracts, nearly half (33) cases were of excision procedures. The 109 Canadian and American volunteers were reinforced by 68 local Filipino volunteers, including 9 doctors and other medical professionals. The Canadian Volunteers included: Aida Buendia RN, Roger Buendia, Amy Chantengco, RN, Abito Collantes, Maxima Collantes, Pablo Garcia, Jr., Eric Hill, Sharon Hill, RN, Sharon Homer, Dr. Denise Koh, Dr. Jose Cresente Madrilejos, Dr. Mary Madrilejos, Amado Mendoza, Consuelo Mendoza, Marcelino Mendoza, Dr. Raymond Padua, Dr. Rudy Padua, Evelyn Padua, Lulu Regimbal RN, Kim Reimer, Delia Saavedra, Luis Saavedra, Amy Sangalang, Felix Sangalang, Necita Tejerero, Carmelita Tolledo, Leo Tolledo, Victorina Tualla, Conrado Tualla, Marcelo Tualla, Conrado Tualla, Jr. The Winnipeg group of volunteers was,organized by Consuelo and Amado Mendoza Sr. The community showed gratitude by hosting festive parties with wonderful local delicacies in our honour. We got to taste such goodies as buko juice, tikbol, gabe gabe, lechon, tilapia, fresh mangoes, guava, pineapple, jackfruit, dinuguan, pili nuts.

I learned and felt so many things during this mission: the sadness that there were so many who couldn’t be seen, the frustration that a lot of what I prescribed/advised would only last a short while with little to no follow-up, the fear that I couldn’t and would never be able to do enough, the appreciation and guilt for what we have in North America. I was angry at the difficult circumstances Filipinos had to face. But I was also proud of my vibrant culture, the steadfastness and strength of my forebears, the kindness and generosity of Filipinos. The mission solidified my love for a country I had never really known, but whose influences were enmeshed in my daily life in Canada growing up. Not only was this mission an excellent experience for my medical education it was an important step in my journey to understanding my roots.