Cultivare 2020

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The Philippine Society of Public Health Physicians (PSPHP) is one of the leading societies in the country that promotes and focuses on the practice of public health. It is a SECregistered organization which aims to be a globally-recognized, locally relevant society of Filipino public health practitioners committed to advance the science and practice of public health towards the achievement of better health for all Filipinos. Founded in 2018, the society is supported by donations from fellow public health practitioners, non-government organizations and various agencies.

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Editor-in-Chief

Dr. Niko C. Cedicol

Editorial Team

Dr. Helen Sigua Dr. Rene Andrew Bucu Dr. Lester Sam Geroy Mr. Jerome Mejarito Mr. Paolo Encarnacion Ms. Christelle Alconera

Cultivare Coordinator

Mr. Teddy Dizon

Layout Editor

Ms. Emerald Bartolome

P S P H P A D D RES S Ruiz Building, 365 El Grande Avenue, BF Homes, Paranaque City CON TACT DETAILS Email Facebook Twitter

phconsecretariat@gmail.com Philippine Society of Public Health Physicians (@publichealthphysicians) @psphpofficial

Cover Photo Credit Shutterstock/MBLifestyle

During the 1st Public Health Convention (PHCon) held last September 2019, the PSPHP launched a magazine entitled, CULTIVĀRE. Out of the society’s desire to inculcate knowledge and share advocacies to fellow public health practitioners, CULTIVĀRE was conceptualized to capture all these passions that linger in the hearts of public health practitioners as well as institutions and agencies with similar lenses.

C U LT I VĀ R E is Latin word for cultivate which symbolizes how entities share, hone, or complement

one another to grow and create synergistic impact to society through public health. It captures the society’s adherence to its set values (excellence, bayanihan, responsive service, respect, accountability and humility), and motto (Opus, Virtus, Scientia) as it nurtures an engaging environment for public health practitioners to freely enhance their contribution to nation building through health systems approach.

This magazine is a vital communication link that is open for everyone who wishes to contribute to cultivating fellow public health practitioners and make a longlasting impact at all levels.

6 Photo Credit Shutterstock/MBLifestyle

Mission Collective Representation Development of Profession Community of Practice

Vision A globally-recognized, locally relevant organization of Filipino Public Health Physicians committed to advance the science and practice towards the achievement of health for all Filipinos

Values Excellence Bayanihan Responsive Service Respect Accountability Humility

Strategic Objectives Professional Development Membership External Affairs and Communication Finance Management Internal Policy Specialty Development Business Development Scientific Credibility 7

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Table of Contents Cultivare

Your Stories

Read about Cultivare’s origins and well wishes of our leaders

52 Gateways

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Cultivare Origins

09 Messages 15

Editorial Page

PSPHP Learn more about PSPHP’s principles 18 Membership 20

Strategic Direction

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Core Competencies

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Building Our Expertise in Public Health

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The Last Drink

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Beyond the Clinical: Applying a Systems Approach to Addressing Mental Health Issues during the Pandemic and Beyond

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Advancing Planetary Health for Climate Adaptation and Pandemic Prevention in the Philippines

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Overcoming Borders

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Moments with the Secretary General

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Lesson This Pandemic: Multi-level Systems Resilience And Intelligence

64 Aida

COVID-19 Pandemic

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Why I am a Public Health Academic

The society’s take on the Pandemic 28 COVID-19 Recommendations to the President

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A Heartfelt Advocacy: Pediatric Palliative Care

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Centers for Disease and Control

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Recommendations for COVID-19 Research and ECQ

Sponsors and Partnerships

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Voice of Frontliners

Know more about our sponsors and partners 70

PB Med Clinic

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Zuellig Family Foundation

Stories from various Public Health Professionals

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Pinoy Fertility Health

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Public Health Story: A History of Spirituality and Health

76 TRANCCES

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Blazing the Trail for Building Resilient Health Systems in the Philippines

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Health Security Science Group

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Leads for Health (L4H)

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CQMC Health Care: Innovating Primary Health Care in East Pangasinan

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International Health Management Institute (IHMI)

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My Journey as an Embryologist and Fertility Ambassador

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The Ruth Foundation

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Brushes and Stethoscopes

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Philippine Society of Hospice and Palliative Medicine

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Out of the Frying Pan and Into the Fire

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Physicians for Peace Philippines

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Designing for Upheavals

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The Woman in Surgery

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The Birth of “Batang Carlesanon”

Your Stories

86 ReachHealth 88

101 Health Research

90 NORFIL-PFP 91 UBQTY 9

Message from the President of the Philippines

Message My warmest greetings to the Philippines Society of Public Health Physicians (PSPHP) as it holds its 2nd Public Health Convention.

An effective and responsive public health system is vital to the well-being of our people.

Now, more than ever, we need your specialized profession in our fight against the COVID-19 pandemic.

Rodrigo Roa Duterte President

Your strategic leadership and institutional collaboration to address various public health concerns have enabled many Filipinos to lead healthier lives.

I am confident that the PSPHP will continue to adapt to the growing and changing healthcare needs of our people. Together, let us work to achieve a stronger and brighter future for all.

May you have a successful event.

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Message from the Vice President of the Philippines

Message Greetings of peace and solidarity to the Philippine Society of Public Health Physicians (PSPHP) as you gather for your 2nd Public Health Convention (PHCON).

Leni Robredo Vice President

In these extraordinary times, our communities, our leaders, our medical frontliners, and every Filipino -- focus all our energies in defeating the virus first. But you, our dear doctors, nurses, and health workers are our first line of defense and we are deeply grateful for your hard work and sacrifice. And it is even more inspiring to hear that despite the heavy burden placed on each of you, your dedication to empower and innovate as public health physicians and practitioners remain burning.

This year’s PHCON is proof positive that no pandemic can bring us down: we will push forward and seek partnerships not only to achieve better health for all Filipinos but also to allow for improved health systems in the country. I hope that this convention will lead you to create linkages and innovations for the benefit of our kababayans, most especially those in the margins. May you have a productive virtual event. Mabuhay kayong lahat.

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Message from the Secretary of Health

Message Greetings to the Philippine Society of Public Health Physicians on the occasion of its 2nd Public Health Convention.

During this time of COVID-19 pandemic, I wish to extend my heartfelt thanks and appreciation to the dedicated public health physicians in the country who have been constant allies of the Department of Health in containing COVID-19 infection and transmission.

Your theme, “Health for our People: Designing Change”, is indeed very appropriate in this challenging time as it tackles different concepts and strategies in achieving Universal Health Care through people empowerment, social innovations, partnerships, and health systems development.

Francisco T. Duque III, MD, MSc Secretary Department of Health

I thank your organization for constantly advancing the Department of Health’s thrust of providing excellent public health care, especially to geographically isolated and disadvantaged areas. Collectively, all our efforts count. Let us work together to promote and further advance public health in the country.

Congratulations on your marvelous achievements in the arena of public health. Mabuhay po kayong lahat!

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Message from the Chairman

Message My dear colleagues in public health, we are on the brink of balancing health and economy and while our nation is facing this pandemic, numerous policies and strategies have been laid down with varying degrees of success. Some may fail, some may succeed. As an archipelago, we have been exposed to constant barriers such as disasters and calamities, endemic diseases or infectious diseases, among others; but we constantly evolve to face these challenges. Luckily, we Filipinos are resilient individuals.

Luisito Ruiz, MD Chairman

While we are facing extraordinary challenges and circumstances, we continue to design programs that will fit the scenario, the governance structure, the resources and especially, the Filipino people. Lest we forget the economic crisis that we may face, health of our people should also be protected equally.

Again, we will never be successful with our health programs and advocacies without the participation of the public, the community and all sectors. We must bind all our efforts into one cohesive approach, innovate in order to be more efficient, seek partnerships in order to sustain these health programs, and most of all empower our people by continuously providing the right information and guidance at the right time.

Designing change starts from ourselves and we hope that it will resonate across all sectors; and while we are doing that, let us inspire more people to work hard, be positive and protect their health. To PSPHP, your works and contributions to nation building have been unprecedented and I hope that with our early beginnings, we continue to serve the country to the best of our knowledge, abilities and potential. Mabuhay po tayong lahat!

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Message from the President

Message To my PSPHP family, let me congratulate first our existence as a robust and inclusive society. We are now serving the country for three years since our inception.

Mabuhay tayong mga public health practitioners ng bayan!

Lester Sam A. Geroy, MD, MPH, MSc President

As we expand our advocacies in the public health landscape, we also continue to understand the variations in approaches especially when dealing with health systems. With the increasing demand for health services, we are faced with limited supply; for instance our human resources. Couple this with the pandemic situation, and push it even further with social determinants of health that remain unresolved, push will definitely come to shove that it will be high time to design even stronger health systems and exhaust all opportunities just to improve the health of our fellow countrymen. That is the reason we exist as a society – a society that hones young public health practitioners to see beyond the normal, to be critical thinkers and health systems managers, not to forget our simple and humble offerings of help and care to our fellow Filipinos suffering from illness or disease holding on to their dear life.

My fellow public health practitioners, this year has been tiring for most of us. We understand that we also have our limitations. But with the collective actions of our colleagues not just in public health but across all professions, sectors and agencies, we believe that no amount of challenges, be it a pandemic, can bring us down. Let us all be advocates of public health no matter what our fields are. After all, it is the health of our people that is at stake. Muli, mabuhay ang PSPHP, mabuhay ang kapwa Pilipino. Manalig sa Diyos, magtiwala sa batas at manatiling malusog po tayo!

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Editorial

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Photo Credit Pexels/Rica Tejada

Deep Breaths for 2020 Niko Cedicol MD, MPM

Health as a right has been the battlecry of most nations even before the Alma Ata Declaration in 1978. That “right” is not easy to obtain as most nations are heavily burdened by several barriers that eventually take a toll on people’s health, such as the widening gap between the rich and the poor, failed governance, and economic crisis for instance.

The recent series of events in the country led to the consensus about the need to further strengthen the Philippine Health Care system.

From the Taal volcano eruption, Dengvaxia fiasco, to polio reemergence; and from Universal Health Care to jeopardized social health 16

insurance, it cannot be disputed that respect for the scientific method, humanity, passion to serve and good governance are among the core elements and values necessary for a successful response to a health crisis. Although these issues racking the health sector are systemic and multifactorial in nature, certainly there are ways to resolve and gradually lift the apprehensions most individuals have felt, not to mention the dwindling trust in our government’s response.

Deep breaths, my friend, for we will surpass this soon.

This exasperating COVID-19 crisis has taught us everything from self-care and cleanliness,

to environmental and wildlife protection; from detecting depression, to predicting future pandemics; from loving your family more than ever, to repenting in front of the Supreme Being.

Meanwhile, it has also taught many to be more assertive of their rights and show that freedom of expression is one great tool to influence policies and decisions of higher ups.

The inexorable COVID-19 has led to the realization of the need for advanced research on viruses, its properties, nature and weak spots. Experts, being replete with knowledge and technologies, have started clinical trials for vaccines. Meanwhile, there are others who have responded in favor of the economy over health or vice versa, but in the end, we really cannot dichotomize the two because both are interdependent on each other.

Concerted efforts and listening to the call of the people (especially the marginalized citizens) will certainly provide directions and shed light as to how the country will face the pandemic and eventually recover.

Parallel to this treacherous virus is the spike in the number of COVID-19 positive patients, which has also opened another issue on data management. Undeniably, handling voluminous information can be taxing, but this should not deter the government from releasing accurate information to the masses. The sheer volume of patients hit by COVID-19 far from our vision of a flattened curve, the alarming number of unemployed citizens, and the call for a timeout by health care workers are some indicators of an overburdened health system. Deep breaths, my friend, for we will recover soon.

Akin to these issues are our fellow countrymen who are also on the brink of losing their jobs and eventually hope. They need support and a helping hand. With prolonged trepidations from living in unfamiliar situations and uncertainty, Filipinos have exerted their best to live and explore all possibilities just to have something to feed their children and secure the next days.

Amid these circumstances, it is heartwarming to see Filipinos enliven the spirit of bayanihan which is inherent in Filipinos. This is something we can look forward to and sustain.

The forthcoming years may no longer be the same. Awareness with our surroundings and the self in terms of building up our immunity have become part of our routine. But equally important is awareness of protecting others around us. We are only safe when others around us are. We realize these are acts of kindness to both self and others: Do I comply with wearing the mandatory mask and face shield in public?

Do I practice social distancing? We have started to think collective and systems-think the way we handle and will be handling the next challenges.

This shift in mindset change is in itself a breakthrough. After we emerge victorious in this pandemic, we should not be complacent from then on. We are not yet done. Antimicrobial resistance, emerging and reemerging infectious diseases, non-communicable diseases, the continued proliferation of illicit drugs, the rising urgency of mental health, among others, are things that we all need to prepare for, not just by the government but everyone. Similarly, several sectors must work hand-in-hand to uplift the country’s critical economic status alongside strong values and principles.

Deep breaths, my countrymen. Humanity is still fighting to survive this pandemic. What the field of public health envisions as we trudge these trails is for this veil of darkness to unfold and for other sectors to be one with public health and the people. Top-down approaches must meet with the bottom-ups. Listen to the people. Solidarity and freedom are not achieved when shortage of rights prevails. Our rights to health should be exercised at all times because health, ultimately, is the most valuable asset we have. We should protect it at all costs. With every precious breath. So, it all starts and ends with taking a deep good one.

“Listen to the people.

Solidarity and freedom are not achieved when shortage of rights prevails.�

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PSPHP Membership We are a Society of physicians dedicated to guide the community, local government, agency, health organization, medical office or program in pursuit of group, community, and societal health goals.

Who We Are

What We Do

We are a society of physicians dedicated to guide communities, local governments, agencies, health oranizations, medical offices, or programs in pursuit of group, community, and societal health goals. In the spirit of camaraderie and professional support, the Society shall encourage entry and strive to uplift the practice of all public health physicians towards credibility and quality. The Society shall also form a strong link with clinical and individual-based medical specialties to the interest of populations and communities based on evidence, sustainability, and the Philippine context.

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Annual Conventions

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Trainings and Crash Courses

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Support to Information Campaigns

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Technical Assistance

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Development of Modules

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Emergency Response

Why Be A Member A network of Public Health Physicians. Members of PSPHP are given the opportunity to become part of a large Philippine and global network of professionals in the same field of expertise. Members shall have access to information and referrals to possible conferences and paper presentations, as well as funding and career opportunities. PSPHP members are engaged in a wide scope of work from communities to hospitals to government agencies, academe, research firms, NGOs, the private sector and international organizations. The wide scope of the field brought by the differences in expertise by the members shows how vast the opportunities are for the members of the Society.

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An emerging “specialty.” Public health is becoming more and more relevant to the Philippine healthcare system accelerated by changes in economic and socio-political developments. With the rising need for primary care and the goal of universal health coverage, public health specialists shall be needed in strategic assignments and positions. We have the opportunity to pioneer the scientific development of the field and respond to the rising challenges.

What are the criteria for membership?

Members with the following criteria are entitled to become full members of the Society: • Doctor of Medicine; • At least three (3) years of experience in the field of Public Health; AND • Any of the following (whichever applies): » Masters in Public Health, related or equivalent field » At least three (3) peer-reviewed publications in Public Health » 100 CPD units related to Public Health that will be offered by the Society.

The Committee on Membership shall finalize the criteria for Associate Members that will be implemented starting 2021. Associate Members will include colleagues who have not yet fulfilled the criteria and are on track to fulfill them within three years.

How to Become a Member 1. Visit tinyurl.com/psphpregistration to fill-up the member registration form.

2. Pay the respective membership fee amounting to Php 2,000. Payment shall be made to:

Bank of the Philippine Islands (BPI) (West Ave Del Monte Branch) Account Name: Philippine Society of Public Health Physicians, Inc. Checking Account: 0431-0165-24

Security Bank (BF Paranaque-Aguirre Branch) Account Name: Philippine Society of Public Health Physicians, Inc. Account Number: 000003131828-2

For inquiries and concerns, please contact the Secretariat at psphpofficial@gmail.com or 0947 248 9335.

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PSPHP Strategic Direction As the health sector gradually veers toward radical system change (the UHC Law), there will be complex challenges in dealing with Philippine public health arena, on leadership and governance, on health technology assessment, research and development, on access to medicines, among others; and more importantly, on how to ensure our fellow Filipinos will not succumb to disease or infirmity.

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Since the inception of PSPHP in 2018, the society is continuously developing the field and profession of public health to better serve Filipinos. The society continues to strategically identify, analyze, and a plan around the country’s public health strengths, challenges, and opportunities. Emerging from the discussion were shared values, diversity and inclusivity, collective expertise, existence of networks, influence and relevance, among others, of the society that can serve as leverage to bridge the gaps and challenges. The very nature of public health as a field is a huge challenge since it encompasses a multitude of expertise ranging not just from health sector but across all other professionals and practices.

From 70 founding members to more than 200 across the country, PSPHP continues to refine its strategic direction for the next years to come.

A ten-year strategic plan (2018-2028) has been crafted. Committed to achieving health for all, the society developed the following objectives that will pave the way towards establishing the practice of public health in the country.

PSPHP leadership is established through the Board which is comprised of the Chairman, Vice Chairman, and nine members. Officers and Committee Heads are selected from the Board of Trustees. Nomination for the Board of Trustees is every two years.

As more health policies are being developed and cascaded to constituent offices, institutions, organizations, and units, the more that the public health system and societies must be ready to engage and align its strategies in order to achieve harmonized outcomes. PSPHP cannot do it alone.

Along with various stakeholders, partnership and camaraderie are important aspects that will help in accomplishing these objectives. The current pool of partners of PSPHP is expanding and will continue to reach the outskirts of the country especially in Luzon, Visayas, and Mindanao in order to serve the public.

Strategic Objectives Professional Development Enhance credibility, impact and inspiration of public health physicians through activities and training programmes

Membership Ensure growth, management, welfare and camaraderie of all members and partners

External Affairs and Communication Communicate effectively the mandate of the organization, the role of public health and professionals in society, enriching partnerships with all professionals and sectors, to maximize impact

Financial Management Ensure organizational sustainability through strong financial planning, management and resource generation

Internal Policy Ensure robust internal policy, management and harmony for maximum growth and influence

Specialty Development Define and expand boundaries of public health in the Philippines through curriculum development, implementation and strengthening

Business Development Facilitate opportunities to ensure financial sustainability, meeting demands of the organization, members and the community at large, within and related to public health by leveraging the human and intellectual capital to maximize innovative opportunities for income generation

Scientific Credibility Strengthen organizational credibility through establishment of a working group that could promote the science of public health and its related fields

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PSPHP Core Competencies to lifelong learning and service PSPHP Core Competencies were developed in October 2018 by the Professional Development Committee and was published in Cultivare 2019 during the first PH Convention.

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Opus Core Competencies Public health physicians and professionals are health system managers whose knowledge, skills, and attitude are founded on the competencies needed for health programs and health systems, down to its components. Public health physicians are expected to be knowledgeable of the following knowledge, skills and attitudes.

Knowledge Governance Project Management Ethics • Policy Development Planning • Strategy • Leadership Organizational Development • Change Management Monitoring and Evaluation • Quality Management Health Systems Framework • Innovation • Human Resource Management Performance Management • Knowledge Management Service Level Allocation • Capacity Development • Project Cycle Management Financial Management • Risk Management Understanding of Different Beliefs, Viewpoints and Cultures Systems Design Thinking Skills Policy Development • Guideline Development Cultural competency • Logical Framework • SWOT Prioritization and Resource Management • Mentoring and Coaching Values and Vision Development, Communication, and Implementation • Resource Mobilization • Leveraging Funding Mechanisms • Budget Management Entrepreneurship • Bureaucracy and Navigation Communication and Lobbying • Listening Skills Political Communication • Risk Communication Model Development Attitudes Humility • Openness Enabling • Entrepreneurial Friendship • Patience Integrity • Honesty Solidarity 23

Virtus Core Competencies Public health physicians and professionals are strongly motivated by values, virtues and aspirations in their areas of work. Most public health physicians are advocates, champions and change agents of social, organizational and societal causes and goals. These list of competencies are essential to enable our roles to achieve these aspirations.

Knowledge Community Dimensions of Practice Ethics • Change Management • Systems Thinking Stakeholder Analysis • Intersectoral Collaboration • Social Determinants of Health History of Societies, Economics, Health, Public Health and Medicine Health Promotion • Knowledge Management Skills Community Health Assessment Root-Cause Analysis • Stakeholder mapping Training design • Communication Networking • Collaboration • Negotiation Facilitation • Conflict management • Dialogue Cultural Competency and Understanding Mediation • Advocacy Attitudes Inter-sectorality Openness • Cultural sensitivity Contextual awareness • Inclusivity and diversity Equity and social justice • Initiative and proactiveness Collaboration • Patriotism • Optimism Love • Responsibility • Respect Balance • Level headedness Humility • Humanity • Benevolence Honesty • Uprightness Integrity Propriety Honor

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Scientia Core Competencies Public health physicians and professionals, like other medical and health professionals, abide by enlightenment and the scientific process. As professionals, we have a key role in knowledge generation, analysis, application, and dissemination. These are essential knowledge, attitudes and skills to enable us to pursue the science of public health.

Knowledge Ethics Foundations and History Health Systems • Health Policy • Health History Social Determinants of Health • Epidemiology Basic Public Health Sciences – Microbiology, Parasitology, Nutrition, Health Promotion Biostatistics • Research Methods • Global Health/ International Health Disease Management and Control • Communicable Diseases Non-communicable and Chronic Diseases • Injuries Disaster Risk Reduction • Emergency Management Health Equity • Knowledge Management Data Management • Environmental Health and Planning Health Economics and Financing Skills Sources of Information Information Management Identify Issues / Needs Assessment Community Health Assessment • Disease Surveillance Analysis • Evidence-based Decision Making Strategic Thinking • Contextualization Technical/Scientific Writing Communication Skills

Attitudes Openness • Critical thinking Curiosity • Social justice Truth

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“Do what you can, with what you have, where you are.”

Theodore Roosevelt

27 Photo Credit Shutterstock/MBLifestyle

Public Health Recommendations to the Philippine President Striking the balance between public health and socioeconomic sustainability

Recommendation 1 LGU Classification and Graduated Modified ECQ 1.

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In early August, with nearly five months of living under intense lockdown, Filipinos all over the country were becoming restless and raring to return to their normal daily routines. However, despite quarantine measures, COVID-19 cases were still on the rise with no end in sight. The public felt calls for increased testing and support to reinvigorate the overburdened health system were left unheard. This was further complicated by clamor to reopen the economy and lift the quarantine to enable people to return to work, despite numbers not showing any indication of the virus slowing down. As such, the Philippine Society of Public Health Physicians together with other professional medical and allied medical organizations called for a strategic pause to reassess and realign the government’s COVID-19 response. PSPHP helped lay down recommendations to maximize efforts to flatten the curve while at the same time giving considerations to gradually reopen and restore socioeconomic sustainability.

With members all over the country who are experts in the field of public health, epidemiology, health systems, political economics, community health, clinical management, primary care and social development among others, PSPHP helped develop interim recommendations to serve as guidance for national government in augmenting current response initiatives and guide succeeding policies yet to be crafted.

PSPHP continues to uphold its sworn mandate and service for the country, but this will only be made possible through continuous collaboration across all sectors and societies that share the same vision of a resilient community and nation.

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Pursue LGU classification (based on severity) and adopt graduated modified ECQ. The classification shall be based on risk/ vulnerability and categorized as A-B-C-D, traffic light colours (red, orange, yellow, green) or levels.

Apply a criteria, scoping or dashboard for stepping down based on principles guided by epidemiology, health system capacity and socio-economics. This is consistent with recommendation with several groups including the University of the Philippines and PIDS. Most likely most provinces in Visayas and Mindanao (except cities and those with many cases) can be the first ones to gradually lift ECQs. Those that are able should ensure testing, contact tracing, management and monitoring, and ensure health sector capacity.

Areas with the greatest number of cases (NCR, Calabarzon, Central Luzon, Davao, Cebu) will likely be Type A or most at risk. These will be the last to lift ECQs. The succeeding recommendations listed below are also dependent on categories of LGUs/ Provinces and Cities based on risk.

Recommendation 2

Recommendation 3

Community Classification and Actions

Hospitals, Health Facilities and Networks

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Communities remain as our first-line of defense. Families as units of health care have a great role in health literacy, health prevention and health-seeking behavior.

Villages/ barangays can likewise adopt classification based on severity. There are variations on risks among barangays within a city or municipality.

Continue the approach to test, trace, isolate, manage and monitor. Once patients have been cleared from COVID, they and their families should be reintegrated well.

Continue to prioritize high risk populations: high density areas, elderly homes, prison, etc.

Enhance risk communication to support community reintegration strategies.

Maximise the role of BHERTs and other community workers in contact tracing and other essential services. It is best to apply multi-sectoral actions at the barangay level.

Collaboration between health, military and LGUs for contract tracing and monitoring of community measures.

Explore RDT testing for health workers and front liners (e.g. police and military), potentially with Chest X-Ray (for viral pneumonia). In areas with limited resources, clinical criteria/ scoring may be adopted and strengthened.

Guidance from DOH and Professional Societies on the use of RDT, IgG/ IgM test kits on different population groups should be supported and disseminated.

In the process of gradually lifting ECQ, protocols for physical distancing and infection prevention and control should be observed. These include mandatory wearing of masks, limit and events to smaller groups of people e.g. less than 10.

Performance accountability framework should be established in local governments.

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LGUs should ensure functional networks and referral systems, including provision of transportation. This is an opportunity to strengthen local health service provider networks that will address both COVID and non-COVID health needs of the populations they serve. The backbone of such could be the existing provincial health system, comprising both public and private facilities/ institutions, with pre-hospital care or medical direction (e.g. 911 or 117) that will be linked in a Health Care Provider Network as elucidated in RA 11223 (UHC Act).

A rapid health system/service delivery stocktaking should be undertaken by LGUs taking note of community level isolation, primary, secondary and tertiary care facilities as well as the necessary laboratory facilities for COVID testing. LGUs and civil society should collaborate to determine availability of PPEs and medicines.

Explore public and private hospitals that will be categorized “COVID” and “nonCOVID.” There will be health facilities that will be mixed.

Hospitals and/ or LGUs should ensure transportation for relatives who need to claim the remains of their families (COVID and non-COVID).

Explore the value of RDT + PCR, potentially with Chest X-Ray (for viral pneumonia), this is more for public health perspective, not clinical diagnosis.

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Recommendation 4

Recommendation 5

Businesses

Transportation

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Companies that have established work from home and online arrangements should continue this.

Identify sectors that can resume work e.g. warehouses, construction, food manufacturing, production of PPEs, disinfectants, etc.

Explore RDT test for employees, potentially with Chest X-Ray (for viral pneumonia). RDT in the workplace can be pre-requisite for certain businesses to resume. This includes employees of manufacturing, front liners, etc Malls may even be reopened especially in low risk areas, with protocols on physical distancing/ new normal. Services that can open are essential needs, maintaining 50% capacity to maintain social distancing.

Emphasize “buy-and-go” and “take-out food” services.

Reconfigure workplaces, malls, fast-food and restaurants based on the new normal/ physical distancing. Examples would be the implementation of one-way grocery aisles as implemented in other countries and imposition of designated entrances and exits only as already implemented in groceries and markets.

Businesses and workplaces should have stronger occupational health and public health advise and monitoring e.g. mandatory wearing of masks. Medical Societies for Occupational Health and Public Health will have a role in this.

Businesses should hire group transportation for workers (to give employment for buses and jeepneys).

Definitely big events and meetings will not be allowed for the meantime. As in Singapore, allowable gatherings should maintain only up to ten individuals.

Work sectors will also need to be assessed and prioritized according to their risk, exposure and contribution to the economy.

Prepare guidance per job industry sector on how to implement new work scenarios. This can be a partnership between DTI, Society for Occupational Health and PSPHP.

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Allow transportation services first that are easier to control in terms of physical distance.

Allow tricycle drivers to resume work, 1 passenger only.

Allow jeepneys again, but with limited passengers. Augmentation of income is highly recommended.

LGUs, schools and work places are highly encouraged to rent jeepneys and buses for their workers, while maintaining physical distancing.

Buses or jeepneys to be hired by government and businesses.

Recommendation 6 Opportunities for the poor 1.

Policy makers should consider those who need to really work for survival and how much the government can support in exchange for these people to not be exposed.

2. Identify jobs that can be allowed again e.g. tricycles, food stalls, with proper physical distancing protocols.

3. Highly consider to resume farming, fishing and food production sectors to resume, especially as many of these are in rural areas.

Recommendation 7 Monitoring and evaluation 1.

Decisions should be guided by local data.

Encourage research at different levels answering key research questions to COVID Pandemic response areas. These include: community programs, prevention, risk communication, diagnostics, clinical management, infection prevention and control, pre-hospital care, hospital administration, local health systems and governance, and national governance.

2. Build national and regional capacities in the performance of LGU assessments and M&E (e.g. consortium of academe and civil society) to evaluate effectiveness of their actions. To include measuring success of social interventions, surveillance and contact tracing.

Recommendations for Research for COVID-19 Response and Implementation of ECQ The country’s current battle with the COVID-19 pandemic only underscores further the need for research and evidence-based recommendations.

Amidst the pandemic response, several researches have emerged to aid in developing policies and recommendations on COVID-19 treatment, safety and security protocol for health personnel, and hygiene and physical distancing standards to help mitigate community transmission, among others. It is well understood that gathering local and national evidences and data for analysis and research should be done in concert with the government and health sectors. The task has never been easy for what lies behind these data and information are the lives of our countrymen who are at the brink of either losing or winning the battle. A strong evidence base is necessary to prevent miscommunication and mismanagement.

The recommendations were developed through the PSPHP Technical Group for COVID-19 in collaboration with different experts and agencies which conducted rapid scoping of research questions across various themes. Consultants from Alliance for Improving Health Outcomes, Inc. (AIHO), 101 Health Research,

MetaHealth, University of the Philippines College of Public Health, Healthcare Practice and Policy Management (HPPM) and Physicians for Peace Philippines (PFPP) also provided inputs which were categorized into themes that are anchored on health systems building blocks, health care organizations, clinical management, diagnostics, community health, social determinants of health, and health leadership and management.

These recommendations also considered topics included in the Philippine Council for Health Research and Development (PCHRD)’s National Unified Health Research Agenda (NUHRA) 2017-2022 which served as framework for prioritizing research activities.

On April 29, 2020, the PSPHP released the topics for public information and guidance. These are carefully crafted and aligned with the national objectives to help the country in its fight against the pandemic.

Risk Communication for General Public •

Community Initiatives and Prevention •

• • •

•

LGU Best Practices on COVID-19 response (Incident Command System, Detection and Screening, Community Isolation, Patient Care and Management, Referral Networks and Resource Mobilization Halamang Gamot effective for symptomatic relief and its potential clinical use Scaling up of innovations Pandemic New Normal at the primary care setting after lifting Enhanced Community Quarantine measures and other restricted quarantine measures Providing essential services to ensure continuity of care

Zoological and agricultural areas of concern •

Evidence on animal transmission of COVID-19

These themes and research questions were prepared by the PSPHP Technical Team for COVID-19 Response. We acknowledge the inputs of colleagues, experts and practitioners from different agencies including public and private universities, research firms and health offices at all levels of health services.

• • • •

Public perception and understanding on COVID-19 and related interventions to prevent the disease Miscommunication and fake news Effectiveness of COVID-19 IEC materials, as well as various communication channels Lessons and best practices for COVID-19 risk communication Framing the communication coming from the government by the media

Socio-economic impacts • •

• • •

Economic impact of COVID-19 among middle income households Equity distribution of the Social Amelioration Program (SAP) and/or Philhealth COVID-19 Benefit Package Effects of COVID-19 on food security, social and economic dilemmas of people Environmental and health impact assessment of COVID-19 response measures in the Philippines Social distancing in the impoverished areas of Metro Manila

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Diagnostics • •

• •

•

Validity and reliability of rapid antibody-based test kits for COVID-19 Appropriate and optimal use for serial monitoring of Immunoglobulin G; seroprevalence of COVID-19 IgG and its trend over time across various settings Accuracy and precision of various diagnostics for identifying positive cases of COVID-19 Feasibility of deploying GeneXpert for rapid PCR testing for COVID-19, and its impact on testing TB Genomic or antigenic variance of the COVID-19 strain

Unified Local Health Systems and Local Governance in Pandemic Response •

• • • •

Accessibility of services in urban and rural areas (including functionality and integrity of referral systems) Cost-utility analysis of telemedicine (versus no telemedicine) Lessons, best practices, and challenges among LGU COVID-19 response Impact of the implementation of UHC among advanced implementation sites Recalibrating LGU performance accountabilities

Clinical Management

National Governance and Planning in Pandemic Response

•

•

•

• • •

Variations in clinical management of COVID-19 patients in DOH hospitals Fidelity of centers for COVID-19 response to existing guidelines and look for adoption to suit local context use Efficacy of several drugs or adjunct drugs Development of local and community clinical practice guidelines Continuity of management within the service delivery network and the communities

• •

•

Cost benefit of community-based isolation centers in urban, rural, and GIDA areas versus home and hospital isolation Capacity of health systems to respond from epidemics and pandemics Redefining Philippines’ Universal Health Care Act trajectory to ensure better contribution to global health security during COVID-19 and beyond Framework for maximizing and situating private sector and community capacities, and community capacities (trisectoral collaboration – public, private, people)

Biosafety, Infection Prevention and Control •

•

National capability to counter biological threats (policies, level of preparedness, implementation, health resilience level) Baseline capacity of research and clinical laboratories for biosafety practices (KAP, national standards oversight, availability and capability, contribution of public and private laboratories

Hospital Administration Management • • • • •

Supply chain Surge capacity Financing, costs, resources Health Workforce Clinical Governance

Disease Surveillance, Evidence, Modelling and Projections •

•

•

•

•

•

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Understanding the epidemiologic characteristics of COVID-19 in the Philippines, and its effects on other risk factors for other high-burden diseases and health conditions Comparative analysis of existing models in relation to the actual incidence of COVID-19 in the country Modeling of various policy options, assessment of superspreaders, use of risk index scoring to measure and monitor effectiveness Feasibility and acceptability of using nationwide/LGU-wide COVID-19 dashboards and/or GIS mapping Implementation of existing policies and health guidance on infectious disease prevention and control Current status of data privacy and cybersecurity measures to ensure full use of digital information technologies

Voices of Frontliners Sponsored by Francisco Cervero Liceras

As the COVID-19 pandemic continues to rage around the globe, our frontliners work every day to safeguard the people and the community, containing its spread and running our health systems. We decided to approach the healthcare professionals fighting the pandemic on different fronts. We asked them about their roles, how their work and their personal lives have been affected and what lessons they have drawn from it. These are their voices.

33 Photo Credit Unsplash/Hosein Zanbori

“As a community health nurse, I actively work with our BHERT which takes charge of the daily reporting and monitoring of the status of more than a thousand individuals (mainly LSI, APOR). Working as the sole nurse on a relocation site with more than ten thousand population is exhausting mentally and physically, especially that there is a chance I can transmit the virus to my family. Nowadays, minimizing our exposure is crucial and once exposed, in-depth contact tracing is a must. I never thought this crisis would continue, but this made me stay alert and focused 24/7.”

Loresita A. Rebong, RN Nurse II Calauan, Laguna

“As a previous MHO, the task of dealing with COVID-19 information dissemination and other related issues through our Task Force was entrusted to me. As part of the Public Health Unit in our hospital, we do lectures on families and produce information materials for the public. This pandemic ‘figuratively’ created a barrier between us and our patients. They are now more afraid to seek consultation, lest they become a ‘suspect’. While we maintain our clinical prowess and risk our lives, we are also fearful aside from catching the disease but on transmitting it to others. The challenge also lies in educating and encouraging our patients to seek consultation before it is too late. This pandemic taught me to be more compassionate.

Tagging someone a ‘suspect’ as it brings mental stress and anxiety to patients and relatives couple it with socioeconomic impact in their lives. Having someone whom they can trust is important, and as we do our best to save lives, we also remind ourselves of our purpose.”

Ahmad S. Musahari, MD Medical Officer III, OIC Vice Chairman for External Affairs, COVID-19 Task Force Sulu Sanitarium, Jolo, Sulu

“On top of the usual MHO work, I am the overall COVID-19 manager in our municipality working on assessment of incoming ROFs, APORs, and LSIs along with supervising our team during contact tracing, detection and surveillance. I also monitor our COVID quarantine facilities. Workload definitely becomes heavier and it appears that health right now is ‘COVIDized’ as non-COVID cases, some, despite needing urgent attention, were neglected due to the pandemic. Amid news on frontliners losing their lives, maximizing and spending quality time with our family is of equal importance as to learning when to stay away with them for their protection. This pandemic has highlighted the flaws in our health system which had been existing in the past but are left unaddressed.”

Christian Earvin Bondoc, MD, MPM Municipal Health Officer Igbaras, Iloilo

“I am working as the Head of the NCD Cluster. The NCD program implementation is hampered by the Covid situation. I must continue to work on the adaptation to the new normal. This is particularly challenging especially if we have training that requires physical contact with others. We feel anxious about the unseen enemy, especially that we have elder individuals and kids at home. As a frontliner, that’s an extra kick of anxiety. On the brighter side, this pandemic taught me to elevate or level up my faith to our Creator. For He is in control of everything. Career wise, this pandemic took me to greater heights which I didn’t expect to happen.”

Tristan Jediah V. Labitad, RN, MD Head, Non- Communicable Diseases Cluster Cagayan de Oro City, Northern Mindanao

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“COVID-19. Hearing it the first time scared me but I really thought it can be easily eradicated or contained just like SARS and MERS-CoV. It was my earnest hope it would not reach our place, but it did; which put everyone in shock, fear, and confusion.

Honestly, waking up to another day every day is quite difficult for me since it feels like I’m plunging into a battlefield at the workplace with an overwhelming number of patients/clients wearing all the necessary PPEs we can think of together with my colleagues at the laboratory.

We would be more comfortable to perform Rapid Antibody Tests and Oro/Nasopharyngeal swabs collection for RT-PCR alongside our routine labs if we do away with the PPEs since it causes us to have shortness of breath and we feel feverish wondering if we’re already infected with the virus or is it the suit (especially Level 3) that gives us free sauna bath. Later on, we enjoy different outfits and accept all the calls of duty since our government needs our expertise as Medical Technologists. My favorite Spider-man line goes “With great power comes great responsibility.”

Nowadays, going home after work is not so scary anymore following our own household protocol to protect my family from COVID-19 infection entrusting everything to God with full confidence. With this pandemic scare, I pity my 2 sons for not experiencing full enjoyment in school and exploration in the neighborhood with all the restrictions due to quarantine measures.”

Joy Ruth del Socorro-Bernaldez, RMT Medical Technologist Malaybalay City, Bukidnon

“I was working on health systems projects when the pandemic hit, in one the implementation was delayed, and in the other one the research meetings were cancelled when country borders were shut. Other colleagues had their work brought to a halt as well. I wondered about the ripple effects brought by COVID pandemic throughout the already fragile health systems. Lockdown in the country where I was based, was badly hit, with tens of thousands of our elderly citizens succumbing to the virus- and my family was also affected as well. This situation has been a warning call that people may have the tendency to believe in disinformation as part of the new “infodemics;” and public health professionals as well as healthcare workers must start to learn how to communicate better.”

Francisco Cervero Liceras International Health Systems and Research Consultant Valencia, Spain

“We got pulled out to work in COVID units, ICU, and COVID floors, all are the same but more intense with the wearing of PPE. It has really affected me since initially there was no proper testing and everyone was anxious, in a limbo. We were less protected in the beginning as we only wore PPE Level 2, and when the swab test result came positive, a lot of our staff resigned. After 4 months I also got COVID-19.

As a nurse I’ve been expecting to contract the disease and I was concerned about my family, since I live with a senior citizen, someone with asthma including myself. I also became more sensitive as I face stigma from people that didn’t want to see me. I also got concerned for the children and females stuck in their homes with their aggressors.

I feel like COVID is never going to be gone and at some point it may even get worse in waves and phases. But this has made me more resilient, empathic, and compassionate.”

Abebalyne Icamen, RN Nurse and Adolescent and Sexual and Reproductive Health Advisor Cebu City

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Photo Credit Unsplash/Engin Akyurt

“I am a COVID-19 Volunteer Coordinator in UP-PGH, mainly taking care of volunteers’ welfare including accommodations, schedule, paperwork among others.

I also attend to COVID-19 referrals and a surgeon specializing in Surgical Oncology, I also attend to cancer patients in the middle of the pandemic. I intend to train abroad; however, this pandemic halted that plan.

I felt helpless as well, for my patients who have cancer and other diseases and cannot receive treatment they need due to restricted quarantine measures as well as increased prices of hospitalizations among others.

I learned that we might not be in control of the situation but we are on how we react to adversity.

Somehow, the situation made it clear that in order to survive, we have to be resilient and not be afraid of learning new things. If our way of life is affected, we might need to discover other ways to earn a living.

Adding skills and developing old ones are never a waste of time. Eventually these will help us, and when opportunity knocks, we must be open-minded as well.”

Anthony L. Dofitas, MD Surgeon Metro Manila and Sta. Rosa, Laguna

“As an internist in a district hospital, our primary role is to provide appropriate management to admitted COVID probable and confirmed patients. Currently we are admitting an average of 3-4 COVID probable patients per day. The pandemic has greatly affected our work.

I’ve been very systematic in doing my clinic rounds to non-COVID and COVID patients. I start my rounds to all non-COVID patients and give them the necessary care they deserve. Then I visit the COVID wards where I spend around 2-3 minutes per patient (to lessen the risk of exposure) doing quick interviews and assessment without compromising quality of care.

Before the pandemic, I was doing an 8-hour per day shift for 5 straight days. Right now, I am doing a 40-hour straight duty per week to lessen the risk of exposure.

But this schedule may vary from time to time since we have to cover the period of duty of our colleagues who are undergoing quarantine due to possible infection.

This pandemic made an impact on my mental health. My anxiety attacks have been frequenting the past months but I am coping with the situation. But beyond this, if there is one thing that this crisis has brought about, it is the reignition of our Bayanihan spirit.”

Arjay Bernabe, MD Medical Specialist Laguna

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“It is always our responsibility as health care workers to ensure the safety of our patients, educate them in order to prevent diseases, and reduce the risk of transmission. In doing so, we risk our lives, just to improve the health care system of the country. I am proud to be a frontliner, who is considered nowadays as a modern hero. My purpose is not just to inform the public of our services as Physiotherapists, but I stand to inform the public about the safety protocols, educate and raise awareness; and to set as a role model and a leader by motivating the community here in Sulat.

Almost all of us were affected by this pandemic, our works, our lives and our plans, but keep it in mind that these are just temporary. As I have read, God’s plan is always the best, and you must trust HIM with all your mind, heart and soul.

Presently, I’m doing homecare for patients. I had 2 stroke patients making it to a point that I am careful when it comes to handling them. There are times I worry too much about my health, being infected and possibly transmitting the virus to my Geriatric Stroke Patients who are considered as immunocompromised. Whatever the circumstances I am doing this because I wanted them to recover in the shortest period possible.

Depression, as an effect of this pandemic may be the next crisis. As what I have read, Mental Health Awareness should also be prioritized at this moment. Oftentimes we are the unseen profession, but now most people rely on us. I hope one day the government should also prioritize health care, so that no health care workers have to stay away from their families in search for a living.”

Mark Joseph Alday Licensed Physical Therapist and private practitioner Sulat, Eastern Samar

“In February 2020, I submitted my resignation as the Municipal Health Officer in an island municipality in the south. Coincidentally, it was also the time when the pandemic broke out. I found myself jobless. Everything was uncertain at that point and looking for a job was difficult considering the impact of restricted quarantine measures.

But more than the fear of being jobless during the pandemic was the heavy feeling of not being with the frontliners. I should be at the frontline. I made the decision to apply for a job at the DOH and was fortunately accepted. I may not be doing consultations, nor doing contact tracing or specimen collections but I know that I am doing my share in our fight against COVID-19, just like everyone else has their part in ending the pandemic. The unit I belong to takes charge in handling and processing reports from community isolation units as well the health care provider network. It is crucial for our unit to work accurately as it affects further decisions and actions and ultimately the health system. I face the day in a positive manner and with an open mind, knowing deep inside that I have to do my share in these trying times.”

Almusaidi Anik Karay MD, MPH Physician Zamboanga City

37 Photo Credit Unsplash/Il Vagabiondo

Words of Encouragement Our healthcare professionals ended their interviews by giving us words of encouragement.

“Whenever I get tired, I think of those vulnerable individuals who rely on frontliners and because of that, surrendering in this crisis will never be an option.”

Loresita A. Rebong, RN Nurse II Calauan, Laguna

“We will never get tired of giving care.”

Ahmad S. Musahari, MD Medical Officer III, OIC Vice Chairman for External Affairs, COVID-19 Task Force Sulu Sanitarium, Jolo, Sulu

“To all the frontliners: serving is a blessed privilege. May the force be with you.”

Joy Ruth del Socorro-Bernaldez, RMT Medical Technologist Malaybalay City, Bukidnon

“To all my colleagues, this too shall pass. Always be on guard. Keep yourselves available to those who need you. We are all in this together!”

Arjay Bernabe, MD Medical Specialist Laguna

“This is not only my story, but also your story.

Our story!”

Mark Joseph Alday Licensed Physical Therapist and private practitioner Sulat, Eastern Samar

“I know that I am not alone in this fight. The pandemic has brought us together and made us realize that indeed partnership and networking are important as well as teamwork and unity.

Those are what we need so we can heal as one”

Tristan Jediah V. Labitad, RN, MD Head, Non- Communicable Diseases Cluster Cagayan de Oro City, Northern Mindanao

Almusaidi Anik Karay MD, MPH Physician Zamboanga City

“To my fellow health care workers, I know you are tired, by doing rapid tests, swab tests, from countless overtime and restless nights, but I hope one day, this will be paid off. Many of us died but still we are fighting and that’s the most valuable thing that only health care workers can do and I am proud of it.”

“It would be selfish to say that I can inspire our fellow frontliners, since all of them have been running on nothing but spirit and will since Day 1 of the pandemic. I have nothing but utmost respect and admiration to anyone brave enough to wear a mask, PPE...and serve.”

Mark Joseph Alday Licensed Physical Therapist and private practitioner Sulat, Eastern Samar

“Laban! Just keep going, it is going to end!”

Abebalyne Icamen, RN Nurse and Adolescent and Sexual and Reproductive Health Advisor Cebu City

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“Sa mga kapwa ko frontliners, bagama’t minsan tayo ay may takot at pangamba, lagi nating iisipin na ang bawat pagkilos ay ambag natin sa iisa nating inaasam – ang mapuksa ang pandemya para sa kaligtasan ng ating mga mahal sa buhay, mga kaibigan, mga kakilala at ng pamayanan. Padayon mga igsuon!”

Anthony L. Dofitas, MD Surgeon Metro Manila and Sta. Rosa, Laguna

Your Stories

39 Photo Credit Unsplash/UN COVID Response

Public Health Story: A History of Spirituality and Health Nezer Aben Soriano, MD, DFM, FPAFP Editor’s Note: Rarely do we realize that our current health system is a product of an age-old religious or spiritual conviction that has evolved and has been challenged by various historical occupations that gradually transformed our approach to public health. In this article by Dr. Soriano, he will bring us back in time and brief us on the connection between spirituality and health.

Our current public health system is greatly influenced by our religious beliefs.

Religious convictions and beliefs have influenced the Philippines’ approach to health care throughout history, moving from a holistic approach to fragmented care. To understand this transition, we look back at the early days of health care in the Philippines before the Spanish came, the influence of the Spanish period, the contributions of the American period to public health, and the Commonwealth era.

During ancient times and even today, tribes in the Philippines have a religious leader. They have been called many names depending on which location, but these leaders are popularly called the Babaylan. According to sociologist and anthropologist Marianita C. Villariba, a Babaylan is “a specialist in the fields of culture, religion, medicine and all kinds of theoretical knowledge about the phenomenon of nature”. In ancient Filipino society, the babaylans are mostly women who are believed to have an extraordinary ability to harness the power of nature and are able to summon into the spiritual world. They have such great knowledge and skills that their functions include the role of community leaders, warriors, community defenders, priestesses, healers, sages and seers. In early Filipino times, there was no defined dichotomy between the physical and the spiritual realm and it is doubtful if there was a concept that distinguished what is spiritual and what is physical. However, what is clear is that the babaylan saw the communion of the self (individual) with nature and the spiritual world. Thus, the Babaylan had a holistic approach to health.

The Babaylan took into consideration the role of the community to the individual, the environment and nature, and even the spiritual realms. Their approach was population-based and multifactorial. Even before the determinants of health were described as important to population health, the Babaylan already had the same lens with an inclusion of nature and the spiritual realm.

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Photo Credit The Legacy of Public Health, 2014

It would be proper to say that the first Filipino doctors or health care practitioners practiced public health.

But then came the Spanish colonizers, establishing a new approach to health care. The first hospital in the country was established in Cebu to cater to the needs of the Spanish naval force affected by the resistance and the illnesses of the tropical climate. With the arrival of the Spaniards also came the clergy, who introduced Christianity to the natives. The Catholic Christians not only cared for the sick but also evangelized them to repent for their sins and convert to Christianity so they can get well. An example of the work done by the earliest missionaries who came was that of a Franciscan missionary named Fray Juan Clemente. The 54-yearold Fray Clemente took pity on the numerous beggars who flocked to the gates of the convent in Intramuros. To aid them, he concocted herbal medications and salves to apply to their wounds.

When their small chapel could no longer accommodate the patients who arrived in droves, Fray Clemente sought help from the community and the clergy to put up the Hospital de los Indios Naturales, now the San Lazaro Hospital.

Other hospitals were also established to address plague and disease outbreaks, such as the Hospital dela Misericordia, now the San Juan de Dios Hospital.

The religious orders became the main administrators of the hospitals, which were the closest institutions that addressed the public health concerns in the country.

The religious understanding of illness as a dynamic of good and evil was patronized, even after the Germ Cell Theory being introduced in the 19th century. The sick were still sinful and needed to be separated from the community until they have been washed clean from their sins.

During the early years of Spanish colonization, the Catholic faith was the official religion of the country and it gave great power to the church as both spiritual and secular leaders. Most of the established hospitals had religious workers taking care of the sick. There was no single department of health to address public health concerns, but there were hospitals catering to the public health needs of the community. As such, addressing public health concerns were at the burden of the hospitals. These hospitals were supported and governed

were addressed by the creation and improvement of specialized facilities.

These efforts were supported by the private sector, volunteer organizations, and religious groups who became the government’s partners in providing health services for free or at a nominal cost.

During and after World War II, there were changes and new concepts affecting our public health system, such as the separation of church and state and the human rights movement. These changes gave rise to concepts such as health as a human right and that the state has the responsibility to provide health services to the people. Yet, the strong influence of the religious beliefs of the community has affected our policies and implementations of public health services and the direction of our health care system.

Photo Credit www.asianjournalusa.com by the Spanish government or the clergy assigned.

The arrival of the Americans saw great strides in the public health system in the country. These changes in the public health system were characterized by the recognition of public health problems and the establishment of specialized institutions like the leper colony, TB hospitals and other health care institutions. The American health workers, led by Dr. Victor Heiser, worked to establish a public health program in the country. To address the country’s public health situation, the American era saw the influx of medical missionaries. These medical missions focused on serving the underserved areas in the Philippines.

This brought in the American brand of Christianity which helped not only the sick, but also the marginalized sectors of society. Rebecca Parrish, an American missionary known as the first female physician in the country, established the Dispensaria Betania in Santa Cruz which later became the Mary Johnston Hospital (MJH) in Tondo.

They catered especially to women and children, who were recognized as vulnerable groups needing health care.

One of the concerns during the American period was the geographical divisions of their missions. To solve this, the Comity Agreement among churches was developed which saw the establishment of different hospitals managed by their respective denominations. The division was: the Methodists (1898, most of the lowland Luzon and north of Manila setting up MJH in Tondo); the Presbyterians (1899, Bicol, Southern Tagalog areas and some parts of Central and Western Visayas setting up Iloilo Mission Hospital (IMH) in Iloilo); the Baptists (1900, Western Visayas setting up Capiz Emmanuel Hospital);

the United Brethren (1901, Mountain Province and La Union); the Disciples of Christ (1901, Ilocos, Abra, and Tagalog towns); the Congregationalists (1902, Mindanao except for the western end); and the Christian and Missionary Alliance (1902, Western Mindanao and the Sulu Archipelago). The Adventist and the Epsicopalians wanted to evangelize all over, thus St. Luke and Adventist hospitals were scattered around the country.

The religious groups affected not only the distribution of health care, but also Philippine health policies and laws.

Protestant morals and convictions affected health policies through their advocacy to reduce alcohol consumption, including those pertaining to the buying and selling of liquor, and resistance towards the importation of opium. Their strict morals considered vices like smoking and drinking a sin and detrimental to the body as the temple of God. The American Protestant brand of Christianity emphasized the role of the individual person shifting the focus of health away from the community and towards each person.

The Commonwealth period saw Filipino leadership in the management of the public health sector in the country.

President Quezon established the Ministry of Public Health and Welfare to oversee national public health concerns with the support of the private and religious sectors in the country. With Dr. Jose Fabella as the first Filipino Secretary of Health, the government built and improved hospitals and health facilities in the country. Training on maternal and child health services were made to be more comprehensive and nurse supervisors took public health nursing courses. Sanitary divisions were expanded; special concerns such as leprosy, venereal diseases, and mental disorders, and infectious diseases

As history unfolds, Filipinos continue to improve and develop the public health system to address the current health situation. The story of public health will continue to be shaped by the narrative of our religious beliefs and spiritual expressions.

Rev. Dr. Soriano presented this history during the 1st PHCON in 2019 organized by Philippine Society of Public Health Physicians held in Pan Pacific Hotel in Manila, Philippines.

Rev. Dr. Soriano is a Medical Specialist and a Residency Training Officer in Southern Isabela Medical Center. He is also the Program Coordinator of Davao Episcopal Area Health Board of the United Methodist Church global Health.

References 1.

2.

3.

4.

5.

Department of Health. (2014).

The Legacy of Public Health. The Department of Health Story. 2nd Ed. Cover and Pages Publishing Inc. Gillian P (2018). World Council of Churches. Retrieved at: https://www. oikoumene.org/en/what-we-do/ health-and-healing/con161162_p218. pdf Rigg, K, Engelman, D, and Ramirez, J (2018). A community-based approach to primary health care. pp105-117 [online] https://www.researchgate. net/publication/319965742_A_ Community-Based_Approach_to_ Primary_Health_Care.

Strobel, L. (2010) Babaylan: Filipinos and the Call of Indigenous.

Teodora Tiglao (1997). A Century of Public Health.

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Blazing the Trail for Building Resilient Health Systems in the Philippines Ronald Law, MD, MPH Out of serendipity, Dr. Law found the public health path and started his journey in the public sector where he grew in his role, expertise and influence to become an accomplished public health professional making his mark as a practitioner, academic and scholar—a real public health trailblazer in his specific area not only in the Philippines but also globally. contribute to the strategic development of major policies and programs on health emergency preparedness and health system resilience in the Philippines.

These programs encompass public health and medical, nutrition, water, sanitation and hygiene and mental health and psychosocial support, hospital preparedness, chemical, biological and radionuclear preparedness and health security.

After finishing his medical education from the UERM Memorial Medical Center, undergoing internship at the Philippine General Hospital and passing the Physician Licensure Examination, Dr. Law initially planned to take the mainstream clinical path – specialize in Surgery and pursue a residency training program in the U.S. With some deliberations, he veered away from clinical specialization and reconsidered his plans of going abroad.

His career started in the corporate sector managing hospital provider networks and directing clinic operations of health maintenance organizations, until he found the path of public health when he enrolled in the University of the Philippine’s Masters of Public Health (MPH) program.

Wanting to apply his newfound learnings after earning his MPH and raring to do something bigger and more impactful as a doctor, he moved to the public sector by working for the Department of Health (DOH).

His public health journey started when he became part of the Health Emergency Management Staff, now a Bureau. Rising from the ranks as a program manager then becoming division chief, his experience in emergency and disaster management at the national level enabled him to

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He was instrumental in the institutionalization of disaster risk reduction and management in health (DRRM-H) systems and its inclusion in the Universal Health Care Act, the National Objectives for Health and other health policies. He continues to play a vital role in providing technical assistance to regional offices and local government units on the development of DRRM-H plans and systems.

He has been responsible for the design, development, and conduct of training courses and modules on health emergency management which has capacitated hundreds of health frontliners nationwide. He also pioneered innovative communication strategies such as the 5K or “Kaligtasang pangKalusugan sa Kalamidad sa Kamay ng Komunidad” to promote community health resilience as a way of life.

As a senior medical officer, he presently sits in various technical working groups in the DOH, other national government agencies and other regional mechanisms (ASEAN, WHO) performing technical advisory functions in relation to his area.

For on-the-ground experience, he was part of the response operations to major emergencies and disasters; from A(H1N1) pandemic, Typhoons Ondoy, Sendong, Pablo, Central Visayas Earthquake, Typhoon Yolanda, Middle Eastern Respiratory Syndrome (MERS), Ebola Virus Disease, the Marawi Siege to the current COVID-19 pandemic; contributing his disaster management expertise to alleviate the sufferings of our disasteraffected fellowmen.

Finding joy in imparting his knowledge of his area of expertise, he is also a professor of public health teaching topics spanning health systems, health policy, environmental health, disaster management to strategic and operations management at the University of the Philippines – College of Public Health, UERM Memorial Medical Center Graduate School and the Ateneo School of Medicine and Public Health. Through the years, he has been able to teach, advise, coach and mentor students and young professionals tracking in public health.

He was bestowed with an Australian Leadership Awards fellowship in Griffith University, Brisbane, Australia where he studied public health emergencies and emerging health concerns. He is also a Fulbright US-ASEAN scholar and recently completed his research fellowship on the topic of health security at the University of Washington where he is also affiliated as an assistant professor in its Department of Global Health.

He is a regular speaker and resource person in conferences, workshops, and conventions locally and internationally.

He is also the author of policies, technical documents, peer-reviewed research articles, book chapters and commentaries on topics related to his field. He has also guested in television, radio and internet shows to share his insights.

CQMC Health Care: Innovating Primary Health Care in East Pangasinan Throughout his career, he was able to grow and foster his network of local, regional, and international communities of practice in the field of health emergency and disaster risk management allowing him to share his expertise and at the same time continually learn from science-based practices that can inform policy and practice.

Marc Delvin Coloma Quero, RMT, MD, MSc

With Dr. Law’s solid contribution to the field of public health, he is wellpositioned to blaze the trail for public health emergency preparedness and health system resilience – an important dimension of our health system in the era of COVID-19 and beyond, in the Philippines and globally.

“In honor of public health professionals in the public sector who are imbued with excellence, professionalism and dedication yet continually face adversities while promoting the ideals of public health, Dr. Law draws inspiration from this quotation: “It is not the critic who counts; not the man who points out how the strong man stumbles, or where the doer of deeds could have done them better. The credit belongs to the man who is actually in the arena, whose face is marred by dust and sweat and blood; who strives valiantly; who errs, who comes short again and again, because there is no effort without error and shortcoming; but who does actually strive to do the deeds; who knows great enthusiasms, the great devotions; who spends himself in a worthy cause; who at the best knows in the end the triumph of high achievement, and who at the worst, if he fails, at least fails while daring greatly, so that his place shall never be with those cold and timid souls who neither know victory nor defeat.”

Theodore Roosevelt

Dr. Ronald Law is the Chief of Preparedness Division of the Health Emergency Management Bureau at the Department of Health.

Primary Health Care (PHC) is fundamentally and intrinsically important especially in communities where access to highly equipped hospitals and medical centers remains a public health challenge. This is aggravated by shortages of specialists and specialized health services. The primary goal of PHC is to make essential medical services accessible. With the changing demands of time, especially during the novel Coronavirus Disease 2019 (COVID-19) pandemic, empowerment of primary care facilities is needed to improve the health of the public.

Coloma-Quero Medical Clinic (CQMC) is innovating primary health care in East Pangasinan. It was founded on August 14, 2019 as a private primary health facility that focuses on preventive health interventions with the aim to address public health problems especially among the underserved. CQMC is located in San Quintin, Pangasinan, a third-class municipality without a hospital and challenged with shortage of medical specialists. A rural health unit exists in the area; however, its capacity is limited. Locals prefer healthcare services from private sectors than public facilities so they would travel miles to seek quality medical care in the cities of Dagupan, Urdaneta, Baguio, and Manila. This may have widened the gap in terms of access to healthcare and possibly delayed diagnosis and management of common and life-threatening conditions. The pandemic has worsened these unfortunate conditions.

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The importance of immunization/ vaccination in disease prevention cannot be emphasized enough. CQMC trained and deployed Wellness Ambassadors to improve the province’s health-seeking behavior. These ambassadors are nonmedical personnel whose primary role is to debunk false vaccine information and to address parental vaccine hesitancy.

Before the foundation of CQMC, the majority of the people in the locality were unaware of influenza and pneumococcal vaccines. Through health education, the trust and confidence of the people was restored. All types of vaccines have since been made available and received by residents of San Quintin and nearby municipalities.

CQMC highly values primary and secondary preventive strategies. It aims to screen patients before symptom onset through regular check-ups and laboratory tests. With the help of a partner clinical laboratory, complete laboratory services (routine and specialized tests) are being offered. Ancillary procedures such as medical x-ray and ultrasound were also made available. These considerably reduced indirect healthcare costs of rural households such as travel costs and transportation.

Home care is also being offered to bed-ridden and physically challenged individuals.

Nurses and Wellness Ambassadors are active partners of physicians in delivering compassionate and quality home care. As early as the onset of the pandemic, CQMC already extended its services by offering free teleconsultation.

It also facilitated issuance of electronic prescriptions and procurement of maintenance medicines especially for the vulnerable members of the population who were not allowed to go out. Hence, optimal care was assured despite the struggles brought about by the COVID-19 pandemic.

Rehabilitation is also an integral part of PHC based on the 1978 AlmaAta Declaration. Access to essential rehabilitation interventions at the primary care level is a key component of universal health coverage. It should be accessible alongside preventive and curative interventions in order

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to optimize outcomes. CQMC has employed physiotherapists to address impairments and activity limitations to optimize the health of aging and injured individuals. This is a bold response to the surge in the number of people who require rehabilitation services close to their homes. At times, stroke patients fail to follow-up because of difficulties in logistics. CQMC aims to facilitate continuity of care, support full physical recovery, and minimize costly hospitalizations and readmissions.

Another public health advocacy of CQMC is prevention of HIV/AIDS and other sexually transmitted diseases especially among the youth. The use of various online dating mobile applications has created instant opportunities for casual spontaneous sex among teenagers.

Although the link between dating apps and the HIV epidemic is still not supported by data, it could be a contributing factor in new HIV infections. Thus, a Twitter account was created to educate the youth on risky sexual practices. High risk teenagers are also being encouraged to avail of HIV screening to know their status. Free and highly confidential HIV screening tests are also available to amenable individuals. Seropositive individuals are then referred accordingly.

Moreover, as most of the teenagers raised concerns about genital warts, CQMC actively advocates HPV vaccination not only among women but also among men.

Acceptance of HPV vaccination is still

a problem in the Philippines since the majority of Filipino men are unaware that they are also qualified recipients of the vaccine.

CQMC Health Care is not a new idea. In fact, as a primary health care facility, it aims to be a role model for other primary health providers. It empowers physicians, allied health professionals, patients, and communities to efficiently manage cases at the grassroots level. In a way, it prevents bigger health facilities from being oversaturated. CQMC believes that a sustainable and empowered primary health care strengthens the overall health system. CQMC will continuously innovate primary health care so more people living in rural areas will no longer need to travel miles for quality medical care – something that all individuals truly deserve.

Marc Delvin C. Quero is the Medical Director of Coloma-Quero Medical Clinic. He is also a Lecturer in Far Eastern University Manila and has finished his Masters of Science in Public Health at the University of South Wales in United Kingdom

My Journey as an Embryologist and Fertility Ambassador Sheila Mae Jallorina-Poulain, MBHARE, PhD(c) was able to help educate them on how to improve their fertility health. As much as possible, I wanted my expertise to provide not only the scientific aspect of fertility education but also the extra physical, mental, and emotional support needed by couples as they navigate infertility.

I completed my Master’s degree in Biotechnology for Human Reproduction and Embryology at the University of Valencia, Spain and I am currently working at the Health Plus Fertility Center. I also pursued courses for Pre-Implantation Genetic Testing at the University College of London. Through these ventures I have had the opportunity to meet several co-scientists and campaigners for fertility education. I am currently part of the group International Fertility Education Initiative founded by Dr. Joyce Harper which consists of different fertility leaders across the world. I have also created the social network sites for Pinoy Fertility Health with the aim of educating and increasing awareness of every Filipino on fertility health.

To deepen my education and to be part of a chain of knowledge passing what I have learned from other scientists to other people is one of the many driving forces I have in pursuing my PhD in Reproductive Science.

People often assume that IVF can offer solutions when they are losing hope. But what is glaring to note is the fact that IVF cannot turn back the biological clock of a person. Hence, we call for better fertility education especially for young people. Through fertility education programs, we do not only prevent future fertility problems but we also help ensure that people understand that reproductive health is a fundamental human right and an important part of their well-being. Moreover, it is time to shift the paradigm from treatment to prevention in infertility. Fertility education empowers!

Before I became an Embryologist, I was a researcher at the Department of Science and Technology (DOST). While in DOST I had the chance to travel to different regions of the Philippines to conduct research for the United Nations Children’s Fund (UNICEF) which has the goal to reduce child mortality and morbidity. From that experience, my passion to make a difference in Philippine health care led me to pursue a Master’s degree in International Health at the University of the Philippines.

While studying in UP, I was also working as an Embryologist at the International Medical Center where I met several Filipino couples seeking consultation with our IVF center wishing to have a baby.

This experience opened my eyes to the declining rate of fertility among our fellow kababayans. Patients from other nationalities would also send me inquiries on how to address their fertility problems. It is not easy for them to communicate because of the social stigma of childlessness. I realized that fertility education and awareness was generally low even among those in reproductive age.

In 2017, I started managing the Embryology Lab at Burjeel Center for Reproductive Medicine in the United Arab Emirates. It provided an immersion on how to counsel patients with their plans for assisted reproduction and their concerns for genetic testing. In return, I

Sheila Mae Jallorina-Poulain works as a Clinical Embryologist at Health Plus Fertility Center in the United Arab Emirates.

She is a member of several societies centering on fertility and human reproduction such as the European Society for Human Reproduction, Middle East Fertility Society, and International Fertility Education Initiative. She started advocating for Pinoy Fertility Health in 2019. She has a Master’s degree in Biotechnology for Human Assisted Reproduction and Embryology and is now paving her way towards a PhD in Reproductive Clinical Science.

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Brushes and Stethoscopes Niko Cedicol MD, MPM One way of conveying a message to a group or audience is through visual communication. The power of visually portraying the plights of fellow Filipinos, the current health status of indigenous people, the humanitarian acts of several organizations, or even a simple innocent child holding the hand of his dear mother, can trigger emotions, maybe fear, rage or joy. The more you capture those images candidly, the more it becomes vivid and lively.

There is another archetype in visual communication wherein certain aspects and elements are given more attention such as the freedom to create your own expression based on your experience; to play with colors to emphasize the mood; and to lay down imagination into realities while adding distortions, disproportions or even simplifying things into basic forms and shapes.

Creating artworks in relation to health has been one of my hobbies as a physician.

Painting those experiences as a public health practitioner is one way to enliven or restore precious moments, trigger awareness (e.g. on dangerous effects of smoking, on treasuring the health of our farmers, maternal health, nutrition, or cancer awareness) and to serve as an outlet when one feels sad, joy, or remorse, be it in relation to current events, society, family, or life in general.

Although not fully explored, public health and visual arts can be utilized for health literacy as well as health promotion, in order to reach a wider public. Visual arts sessions can be used as part of therapy among patients with various conditions (e.g. cancer, mental illness). Watching your learners daub paint with a paint brush, tilt their heads and examine the angle, smile silently or frown unexpectedly and come up with a totally different concept, brings joy and satisfaction to everyone as the artist is able to transform his/her imagination and express their inner feelings into something that can be shared visually with others.

As a former Municipal Health Officer under the Doctors-to-the-Barrio (DTTB) program,

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I was amazed by how well students can portray their thoughts and imagination through arts. For our Rabies Prevention and Control Program in 2017, we organized a poster making contest and part of our social marketing strategy was to distribute tarpaulins and pamphlets where artworks of those students were reflected to convey messages on responsible pet ownership and health-seeking behavior for animal bite victims. These were then posted in schools and strategic places. Months after testing of information materials, an evaluation showed improvement in knowledge and perspective of children on animal bites, rabies, and responsible pet ownership compared to their pretest scores. Although there could have been other factors for the improvement in test scores, school children would mention the visual material as one of the reasons for improved knowledge.

I also remember that time when my coDTTBs were conceptualizing branding for an activity intended for PWUD (Persons Who Use Drugs) during the height of Oplan Tokhang and the CommunityBased Drug Rehabilitation Program. Upon interviewing the PWUDs, we found that most of them were skillful in painting and were interested in art workshops to hone their skills and hopefully earn a living from it. Although it was just an idea, our final branding then was “Buhay na Kulay Para sa Kulay ng Buhay.” In this project, PWUDs were tasked to paint barren walls in schools and other areas (of course with permission and proper coordination), and create murals to express messages on health and disease prevention, hope, unity and freedom. Although I was not able to finish the project in my area, my co-DTTB successfully did so in his area.

My eldest brother Major Sayid C. Cedicol, a doctor in the military service specializing in Emergency Medicine, also shares the same passion. His artworks portray the everyday encounters he has in Mindanao since not much are aware of the life of a physician serving the military. He had his solo art exhibitions in 2015 in J studio in Taguig, as well as in 2016 in Metro Gallery.

Although busy serving the country, he always finds time for the arts.

The ironically tranquil feeling amidst death and blood depicted in Dr. Sayid’s crafts triggers one to realize and reflect how valuable human life is especially as this can easily be taken away during battles and encounters in the field.

Similar to a public health lens, human life must be protected and valued. Being aware of God’s gift of life is tantamount to treasuring one’s health. Dr. Sayid also conducts several art workshops and art therapies especially to fellow soldiers who experience mental difficulties. Along with our art group Makisining (a Los Banosbased art group inspired by the majestic Mt. Makiling) we were able to somehow bring relief and satisfaction to the public through art workshops. During the early months of the pandemic, Makisining also joined in raising funds for personal protective equipment and other medical supplies for frontliners. With such an initiative, our group was recognized in the Gawad Geny Lopez Award last August 8, 2020. Truly, visual arts have the potential to trigger awareness, and promote peace and freedom. On one hand, it can be an opportunity to further expand healthrelated advocacies, or it can be an element for debunking beliefs. But whatever the purpose, art is something we should consider to be part of our public health practice.

Dr. Niko C. Cedicol previously worked as Doctor-to-the-Barrio in Nueva Ecija and as Rural Health Physician in Laguna.

Major. Sayid C. Cedicol is a physician (emergency medicine graduate) serving in the Armed Forces of the Philippines.

“Acute Respiratory De-Stress”

Dr. Sayid conducting watercolor workshop to children in a community.

Graphite on Canvas Dr. Niko Cedicol

Photo Credit Gawad Kalinga

“Natural Causes” Colored pencil and ballpen on board Dr. Sayid Cedicol

“Soon You Will Be Gone”

“Farmers’ Health Country’s Wealth”

Mixed Media on Canvas Dr. Niko Cedicol

Acrylic on Canvas Dr. Niko Cedicol

“I Now Pronounce You Man and Wound” Colored pencil and ballpen on board Dr. Sayid Cedicol

Dr. Niko conducting art therapy on patients in V. Luna Medical Center Photo Credit Makisining Art Collective

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Out of the Frying Pan and into the Fire Anton Oliver Javier MD, DIH “I worry that all this secrecy, all this unwillingness to change, to evolve—to listen to reason—is eroding all that we stand for.

Endangering everything that we have vowed to protect and defend.”

This is how Fr. Saenz in FH Batacan’s pièce de résistance describes his quandary as a scientist coaxing a nation into constructively approaching its systemic dysfunctions while solving a murder case.

In case you have not read it, Smaller and Smaller Circles is a critically acclaimed piece of Filipino literature. Behind the misadventures of its liberal Jesuit forensic anthropologists lies an accurate depiction of the paralysis of government in 90’s Pilipinas. It’s incisive. Candid. You see its value as a reform-oriented kind of person.

What the protagonists need to do to get results is consistent with how public health physicians navigate the intricacies of organizational culture, politics, and sensitivities within the landscape of government. It’s tiring. The odds are ‘never’ in your favor. But if you learn to strike at the perfect moment, you can see that change is possible. And sometimes, with support and help from brilliant people, you can safely pursue the cusp of small, steady, but meaningful reforms.

My personal journey towards policy development work wasn’t straightforward.

Before public health, I worked as a clinician. Doing the ropes – day in and day out – in a primary care clinic for persons with HIV. I loved the work there fiercely but experienced the worst caregiver burnout of my life.

Through the entire continuum of care, patients are taught to navigate “extraneous factors” in addition to problems directly related to HIV. Often their condition was already advanced if not severe by the time they sought treatment. You were often the patient’s only confidant. When your patient just turned eighteen and is with you, an HIV doctor, on his birthday, it’s probably because his entire social support system had already failed. Each day, you earn his trust. The sheer paperwork involved with their prescriptions and social insurance requirements can break your determination. No amount of task shifting with nurses and patient partners could fix it.

Paulit-ulit. We treat them. We see them months later defaulted, deteriorated, and dejected. We wondered if there was a point to this.

The twenty-seven patients I had at my worst day on hospital duty – without meals – was nothing compared to the new cases of HIV each day that were reported at the

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nationwide level. That’s man-hours to be spent laying the foundation for trust so that patients stay in the program. It won’t be soon before long but the front lines will see that mere adherence to appropriate management won’t drive HIV back. It won’t shield the health system from sheer patient volume and the unique needs of the person with HIV. HIV service delivery has greatly improved in the last ten years. Rationalizing the health financing scheme was a game changer to improve service delivery and skew resource expenditure towards early treatment at the primary care level.

But without effective behavior change through smarter health promotion and appropriate mental health interventions, the ecosystem of HIV services was buckling. It’s true that the HIV program has saved many lives. But in my experience, new patients were coming in waves daily, all while old patients who defaulted on treatment would come back with severe disease and even more counselling needs.

The brutal math of infection rates still raged.

One after the other, HIV physicians in the treatment hub I worked in were getting sick, demoralized, or both. Holding on to our commitment to keep patients alive just felt painful. What could ordinary public servants do? HIV health promo initiatives mushroomed where I worked. I volunteered. We placated ourselves with hope. We tried to hold the line.

At my lowest point, something had to give. Between studies and work, my body and my relationships were failing. At that point, I was far along enough in my program to snag a Diploma in International Health if I bailed. If I made that quantum leap of faith... Bahala na. Working on the root of the problem could be therapeutic, I thought.

To preserve my small savings, I also had to put the brakes on university.

Thankfully, some of my professors had not deactivated their courses. I could scan their profiles. I messaged those who managed to make the shift I wanted – clinical to public health. I messaged Lester, our current PSPHP President.

Lester would later link me up with an opportunity to help make things better, thankfully. Much of the improvements in HIV service delivery was directly related to improving and rationalizing health

financing policy mechanisms. At that time, the Department of Health, through a joint project with The Union, was pushing for higher tobacco taxes in the country.

The cause resonated with me because Sin Taxes fund social health insurance. By extension, they fund HIV services. I sent an application the very next day.

Since then, I have held job titles of technical officer and project manager. But the core of my contributions have always been policy development. My portfolio of responsibilities expanded from technical assistance in taxation policy for sin products to tobacco product regulation.

My previous health promotion experience in RITM’s in-house initiatives was helpful in our legislative operations for tobacco.

It’s more of the same problems, only from a different perspective. The root causes of the overbearing health system strain are now more apparent. But the institutions still don’t change overnight. It’s out of the frying pan and into the fire. Tobacco control is also relentless. Demanding.

But for the little things I could do for the brilliant people in health governance? It is worth it.

I heard my patients lost their clinic during this pandemic, though. I wonder today if I did the right thing, or the right thing for me? I’m grateful; I just regret being absent from the front lines. My patients are ‘still’ my raison d’être. After all, I was their doctor first.

Dr. Javier works as Project Manager for a joint project between the FDA and the International Union Against Tuberculosis and Lung Disease. He finished his Diploma in International Health in 2018 at the University of the Philippines Open University. He is an advocate of strategic management in public health.

Designing for Upheavals Katrina Gomez, MD, MPH

The question of nutrition during emergencies and disasters, also known sometimes as NiEm, first sparked my interest when I was an undergraduate student helping during relief operations for Typhoon Ondoy. As the campus still reeked and dripped with floodwater, many of us students began donating and repacking goods to send to the most affected communities. I remember looking down at the assortment of instant noodles and canned goods and wondering how families would survive on these until some semblance of normalcy returned to their communities. It was a question that would follow me through years of blogging about healthy food, learning casually about food preservation, and just about anything to do with food especially during difficult times.

It took a story in our Health Policy and Administration class at the UP College of Public Health for my interest to turn into research and advocacy. One November day in 2017, our professor Susan Mabunga told our class about the situation of the evacuees from the Marawi siege, having just visited them a week before. She mentioned that the displaced families had been living on canned goods, picking out only what was halal. Then she wondered aloud, “what will their nutrition be like after living on those for such a long time?”

Immediately my friends in that class looked at me; it was no secret that I had been looking for a nutrition-related topic for my thesis. I smiled and wrote down Dr. Mabunga’s question in my notebook, knowing then and there what I would be working on as part of my graduation requirements.

It took me about a year and a half until I finally finished my case study that detailed the NiEm systems in a single LGU; logistics had prevented me from centering my study on Marawi or other more remote locations. I learned that nutrition during emergencies was much more complicated than ensuring that each individual’s macronutrient and micronutrient needs were met on a daily basis during an evacuation. It was just as important to

examine the pipeline itself and answer the questions of where, when, and how food aid was procured, transported and distributed to communities in need. I took these insights with me through the writing of my study, and more importantly, into the project that would put it into action.

Mere days after I submitted the finished manuscript of my thesis, I was invited to work on a short-term consultancy to conduct research and policy writing with the National Nutrition Council (NNC). The year 2019 marked the 10th year of the creation of the NNC’s policy regarding nutrition in emergencies and disasters. The number and magnitude of natural and man-made disasters that had marked this decade had served as a reminder for the need to update the policy, to meet the evolving needs of communities prone to such emergencies as well as international standards for aid.

Political upheavals such as the creation of the Bangsamoro Autonomous Region of Muslim Mindanao, as well as cultural considerations such as the prevention of gender-based violence also posed new challenges. More importantly, paradigms had shifted from resilience and survival towards risk reduction and mitigation, thus, it was important to reflect these in the document. In the end it would become more than an update, it would become a rather new design.

Designing a new policy for NiEm was a participatory process that considered not only the expertise of planners and implementors throughout different calamities over the years, but also the experiences of the end-users, meaning the affected communities. The expressed needs of individuals and families who had survived some of the worst disasters since 2009 such as Typhoon Yolanda and the Marawi Siege were important in making the policy more inclusive and responsive to its most important stakeholders, the communities who would receive food aid and nutrition interventions. This journey of qualitative data gathering, drafting, consultations, and revisions was lengthy, but a learning experience for all involved.

In an interesting twist of fate, our team finished the draft of the new NiEm policy and sent it to the NNC for approval during the early days of the COVID-19 pandemic.

I believe that it will be an interesting challenge in the field of NiEm to innovate and eventually create new policies and ventures to serve communities that risk being cut off and isolated, or that may experience great food insecurity during quarantines, lockdowns and times of limited economic activity. Even if I am focused for the time being on serving my local urban community in the middle of this pandemic, I look forward to returning to the field of NiEm. The year 2020 is for new designs in public health, to help people not only adapt but thrive in the new upheavals of this time in history.

Dr. Katrina Gomez currently works as Medical Officer III in the Makati Health Department and recently completed her Masters in Public Health in 2019.

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The Woman In Surgery Dr. Mariz Jane Saldana: Leader, Colleague, Mentor & Friend Maymona J. Choudry, MD, MPH “A good surgeon must have an eagle’s eye, a lion’s heart, a lady’s hand.” – English Proverb

Dr. Maymona J. Choudry

Dr. Mariz Jane Saldana

This is my tribute to one of my inspirations in the Department of General Surgery of Vicente Sotto Memorial Medical Center, to my beloved Chief Resident, Dr. Mariz Jane Saldaña. Her sacrifices, hard work and efforts to communicate and create a harmonious relationship among and between residents from first year to fifth year. There is a lot to be said, but I hope that this gesture would show our appreciation and gratitude for your contributions in making 2020 a fruitful and productive year for us.

Mentorship As a first year resident in General Surgery, I was nervous compared to my other colleagues since I had no friends nor acquaintances among my senior residents. I was assigned to be Doc Jane’s junior resident, hence began my journey and interaction with the best senior resident. Though we are complete opposites, I learned a lot of firsthand experiences from her. During the first few months, she guided me on how to prepare patients for surgery, how to become more efficient during rounds, and how to manage patients in the wards.

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I was even her first assist during most of the operations. I felt blessed to have a senior like her as she would always encourage me to study and give me short quizzes every week to challenge me. I became more confident and independent despite being just a first year resident.

Although she never expected to become Chief Resident, I always had a hunch and believed that she is more than capable of becoming one.

Women Excelling in Surgery Despite surgery being a male-dominated field, there are increasing numbers of women applying to this challenging yet rewarding field. I have seen her talent and competence as a resident and surgeon during conferences, tumor board presentations, in the operating room, and even during our yearly national examinations. Her excellence in every way imaginable is one of the reasons why I have always seen her as an inspiration and a mentor. By the end of 2019, it was announced that she was to be our Chief Resident for 2020, her fifth year of residency. I was stoked and excited to see the next chapter of our journey.

Chief Resident of the Year Being a Chief Resident is an honor and privilege; however, it comes with a lot of hard work and sacrifices. The Chief Resident has the longest and neverending to-do list. There are certain goals that must be achieved within the said year, and it comes with a lot of pressure and stress. From creating schedules of rotations for residents to organizing departmental and interdepartmental conferences, examinations, and presentations, in addition to doing service rounds and completing surgical cases. All of these responsibilities come with the title of Chief Resident, but it is so much more than all that. When the SARS-CoV2 pandemic started, our usual routine was disrupted. The hospital and health care workers had to adapt to new trends and policies. It has been a very confusing and stressful experience to adapt to “the new normal”. Despite all this, Doc Jane was able to face this adversity and create a virtual platform for the residents and the consultants to come together to discuss and continue our learning experiences.

As an individual, she has always been very encouraging and helpful with the residents’ needs or problems. Should a problem arise, or if you have questions or concerns, or you feel like you want to give up, Doc Jane is always there. The best thing about her is that she sees the strengths and weaknesses of each and every one and use these qualities in creating or assigning tasks, partnerships, or teams that best work together. She would always listen to your side, and clarify any problems that would concern you. She always gives the right task to the right person, and there is always a perfect person for that job. I see true leadership and amazing interpersonal skills in her. She just knows how to create an environment for everyone to work together, as a family.

I am truly grateful to be a part of her journey as a Chief Resident in one of the most challenging fields in medicine.

Dr. Maymona J. Choudry is currently a 2nd year Surgery Resident at the Department of General Surgery at Vicente Sotto Memorial Medical Center.

The Birth of “Batang Carlesanon” Wendel T. Marcelo, MD, MPM on COVID-19. Since we are facing a novel kind of virus, the knowledge and evidence we have about coronavirus disease and its causative agent, SARS-CoV-2 virus are quickly evolving. Thus, it also entails regular and timely dissemination of new updates about the virus to the community.

Radyo Timbo-ok and the Carles Health and Nutrition Hour program has been the portal for regular COVID-19 updates and situationers from the local, national and global scene.

The Local Government Unit of Carles established a local radio station branded as Radyo Timbo-ok (Timbo-ok is a Hiligaynon word for “soar high”) that started airing December of last year. This initiative was conceived as part of disaster preparedness activities to serve as an early warning system and information dissemination channel for the community.

Physical access and connectivity are constant challenges for the Municipality of Carles with a population of more than 70,000 spread across 33 barangays, 28 of which are Geographically Disadvantaged and Isolated Areas (GIDA) islands. In this digital age, connectivity can normally be easily addressed by internet and cellphone technology. However, this is not yet feasible in Carles since not all barangays have access to internet and cellphone signals especially in the islands.

As a primary channel for information dissemination of public health concern, a regular time slot was allotted for health and nutrition.

A daily public affairs program also goes on air to disseminate news and information to the general public. A radio program dedicated to disaster preparedness is anchored by our municipal disaster risk reduction management officer. Thus, through Radyo Timbo-ok, the LGU has a channel that can reach the entire municipality to disseminate localized and contextualized information on the COVID-19 pandemic to the residents to help guide their health-seeking behavior and decision-making.

The Carles Health and Nutrition Hour radio program has been the primary channel of information dissemination in the entire municipality especially in promoting behavior to prevent being infected with the virus and transmitting the disease. In this time of “infodemics”, the radio station and the program have been a platform to counter disinformation

Since the imposition of strict quarantine measures from Enhanced Community Quarantine to the Modified General Community Quarantine, the children and youth sector are expected to stay at home (individuals below 21 years are not allowed to go out of their homes). Because of this, the Carles Health and Nutrition Hour program initiated a segment to address and reach out to the youth; thus, the birth of the Batang Carlesanon segment. Even before the launch of Batang Carlesanon, volunteer Carles youth student journalists have been tapped to deliver health news and updates as part of the starter newscast for the Carles Health and Nutrition Hour. The Batang Carlesanon segment is now a regular weekly segment of Carles Health and Nutrition Hour airing every Friday. It is envisioned to be the channel of program by the youth for the youth. The pilot episode of Batang Carlesanon aired last May 13, 2020. The pilot episode started a discussion on the topic of social media etiquette which was chosen as a timely and relatable issue by our youth journalists in the team.

The youth anchors have also talked about “Quarantine Boredom Getaways” to address the boredom experienced by the youth since the start of the quarantine.

Batang Carlesanon is also designed to be interactive with our listeners, especially the youth. Our anchors engage the listeners with questions and they are encouraged to send their comments and insights through the station’s hotline number. Since its pilot airing, Batang Carlesanon has tackled various public health topics. Episodes on “depression & suicide”and “child sexual violence” were tackled at the time when cases of suicide and child sexual violence were reported in Carles. Smoking prevention was discussed in time for the World No Tobacco Day with the thrust of smoking prevention among the youth. To kick-off the Disaster Resilience Month, Batang

Carlesanon talked about child-centered disaster risk reduction. As part of the Nutrition Month Special Series, an episode was also intended to talk about Adolescent Nutrition.

Other topics that have been tackled so far are child rights, youth and poverty, adolescent health, and suicide prevention among the youth. One of the challenges that the programs encounter is the availability of the youth anchors since their service is on a volunteer basis.

The program is relying purely on the commitment of the youth in sustaining this segment of the program for it to remain true to its vision as a youth-led program. It is also being anticipated that when school resumes, there will be schedule and priority conflicts among our volunteer youth journalists. With the continued support and commitment of the Carlesanon youth and stakeholders who believe in the vision and advocacy of Batang Carlesanon, it is with optimism that this program will continue and prosper.

To all child and youth advocates and partners out there, the program is open to all your advocacies for the promotion of the welfare of children and youth.

Batang Carlesanon program is open to partnerships and collaborations to further improve the programming to better serve the children and youth of Carles.

Dr. Wendel T. Marcelo is a Medical Officer in the Municipality of Carles, Iloilo. He is a former Doctor-to-the Barrio engaged in various innovative programs in their community.

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Gateways Angeli A. Comia, MD, MPM

“One’s destination is never a place but a new way of seeing things.”

Henry Miller

As public health physicians, we are faced with challenges and insurmountable obstacles from time to time. At times we may feel saturated within our setting. Therefore, we must learn to take a break and reconnect with other cultures and societies aside from our own. As we travel and discover new gateways, the process imparts new vigor to the mind and heart. Once in a while, we must deep dive in places not just to seek new landscapes but to have better and clearer perspectives on several things. In this way, we will be able to understand that each country, each society, or each individual follows a certain framework and paradigm that is unique and worth learning. As for me, I become more inspired and hopeful as a public health physician to contribute to our nation’s healthcare system which eventually may become on of the best in the world – quality, accessible, and equitable for all Filipinos.

Dr. Angeli Comia is a Project Manager of Zuellig Family Foundation and is currently assigned to Agusan Del Sur for Universal Health Care Implementation under the Integrated Provincial Health systems and Development Program (IPHSDP) and Pandemic Preparedness and Management Response Team (PPMRT). She was a former Doctor-to-the-Barrio assigned in Linapacan, Palawan.

She has been an advocate of health equity through effective leadership and governance since 2013 through partnership with key health leaders in the Department of Health, provinces, cities, municipalities, and barangays of Bicol, Davao, and Caraga regions.

As a health systems strengthening coach, mentor, and trainer, she was also a faculty adviser/panelist of several batches of DTTBs as MPM-HSD candidates of DAP-GSPDM program.

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Building Our Expertise Joel Buenaventura, MD, MPH

Individual

Interpersonal

Community

Societal

Policy Change Mentoring Publications Conferences Practice

Competent

Networks

Proficient

Dr. Joel Buenaventura presented this topic during the 1st PHCON in 2019 organized by the Philippine Society of Public Health Physicians held in Pan Pacific Hotel in Manila, Philippines.

There are several reasons why there is a need to build expertise in the field of public health. These are: • • • •

unlike the clinical track, public health expertise lacks a clearcut path, the current system of establishing public health expertise lacks structure, and definition, public health is a very broad field, and there is a need to establish communities of practice and the science behind the practice.

To define the process of building expertise in public health, it is important to briefly course through the following questions that are all relevant guides when attempting to formulate a framework that will encapsulate the said expertise. These questions are: 1.

2.

3.

4.

5.

What is a public health expert?

What are the areas of expertise in public health?

What are the criteria to become a public health expert?

When does one become a public health expert? and Can one be an expert in more than one area?

At present, public health experts are usually those professionals with public health-related degrees or experiences that have been honed through practice. Professionals such as nurses, allied health professionals, engineers and alike with Masters or PhD in Public Health and related fields may be experts. It is important to note that not all public health practitioners center on doctors. Data scientists, economists or any field and profession that delivers public health-related services may be public health experts. But again, these contexts loop back to the questions posited above.

Expert

Expert

The figure above shows the working framework proposed. The framework is an adaptation and combination of the principles underlying Maslow’s Hierarchy of Needs, Germain’s Generalized Expertise Matter, Dreyfus Model of Skill Acquisition, and the Social Ecological Model. The elements of public health expertise are theory, practice, networks, conferences, publications, mentoring, and policy change. The first two elements represent individual skills that enable one to become competent in public health and take on at different levels depending on the practitioner whether or not it is applied on individual, interpersonal, organizational, community or public policy.

Networks and conferences are important in creating proficient public health personnel. With a solid hold on theory and practice, armed with interpersonal connections, the public health practitioner can venture into publications and mentoring (community level). Part of being an expert is being able to share and inculcate knowledge to anyone and peaks to expertise when societal change ensued, that is through policy changes.

The presented framework can be used as a guide for targeted personal and professional growth, as well as guide for developing and providing structure, and tracking public health expertise.

The matter as to who can be classified as a public health expert requires a collective answer, and it has to come hand in hand with the process to build the expertise.

Dr. Joel Buenaventura is currently the Chief Health Program Officer and OIC Division Chief of the Bureau of International Health and Cooperation of the Department of Health.

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The Last Drink Lester Sam Araneta Geroy, MD, MPH, MSc-HPPF

Photo Credit Watercolor photo created by kjpargeter - www.freepik.com

10 September, 1530H. Holding my disposable cup snugly with two hands, I sipped its warm water. It was the last of my pack of disposable cups I bought more than a year ago. In these two years of working in the Organization, I had learned to drink warm water and lots of tea.

I entered the men’s room which was just beside the drinking fountain. This was one of the first rooms I had entered in this complex when I first came to the office for an interview. Now, it would be among my last visits. I could still remember that day. I wore a light-yellow polo and a red tie – my favorite. My original contract was supposed to last for two months. The two months rolled into more months until more than two years.

The men’s room has not changed in two years – in cream marble, clean and cozy with the same tissue dispensers that provided tissue every time I would come to wash my hands, my face or my nose. I looked at its wide mirror. I had changed.

My hair was shorter now. My eyes were lined with dark circles after 5 months (or let’s say two years) of waking up early, traveling at dawn and working for eight or ten or twelve hours a day and finally traveling home late.

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I drank the cup halfway through. Two years ago, I was younger then, fresh from the cool breeze and natural springs of Mindanao.

My knowledge of public health was strong at the local level. This knowledge of patients and local health workers were my sword and pen. These two years brought contrasting experiences in my career at a very high level that not many doctors or even public health experts would have experienced. Two years of observing how a global health organization works, how health programmes were delivered differently in different countries, how various events affect health of populations, and how health is affected by policies, natural hazards, politics, economics and the media. Here, I gained the value of the written and spoken word.

If there was anything I learned, it was the different facets of communication – from diplomacy to social marketing.

This men’s room is one specific place I will never forget. This is where hard moments of stress were released simply by just washing hands or stretching. It is where I first felt signs of palpitations due to chronic stress. And it is where I informed my boss that I am finally leaving the office for further studies.

I went out of the men’s room and filled my cup again at the water fountain. This cup reminded me of people with whom I have worked with, many of them younger than me. And along with these cups were career talks with colleagues, some younger ones, some more senior and more experienced than myself.

Walking back to my cubicle, I glanced at my boss’ office. It was lit, but he was not there, he was having a meeting. Many times, I would glance to check out his lights. On early mornings, I would check it and usually, I arrived earlier so it was still dark. Many times, the two of us would be left working till evening or even during weekends. It was a story of perseverance.

Room 414-C. I was already back in my workstation. It was a cozy room, friendly and bright because of its windows. At some point, it was the peak of activity during disasters, filled with people, papers, conversations, references, boxes and more. Now it was almost empty. I had removed my personal things (including my swimming bag) and what was left were the basic books and CDs that I do not own. The desktop, the phone, the school supplies, the office chair, the guest chair, the shelves – it will probably be remembered as the best office I would ever have.

It was my last drink. I threw the cup in the ever-faithful waste basket.

It was the end – the end of early morning travels, early morning meetings, teleconferences, BBC radio 3 music background, notes for the record, fruit lunches, Jollibee, Max’s, Pancake House, Shakey’s, Emergency and Humanitarian Action (EHA) lunches, career talks, rainy evenings, murky floods, and late afternoon swimming and chatting on events and ideas. Oh, such full-packed memorable months! God knows the different emotions I had grown with over those years – joy, confusion, love, depression, success, satisfaction, despair, hope and victory.

Yet this is not the end. This is but a mere closing of one chapter in my life to give way to another. Upon leaving this place in a while, I will be dropping by the department store to get a few more things for my trip to Europe in about ten days. In two days, I shall fly back to Cebu where my family is and spend time with them. Life had been exciting and hard – working like a carabao, I had mused many times on my way back home.

As I end this reminiscence, I look back. My life has been filled with comings and goings, hellos and farewells. Now I am almost immune to feeling sad. I know I should not for sooner than I know it, I shall be back. This chapter was like a movement in a symphony.

Its technical difficulties were essential to create a glorious piece of music that unfolds into a series of themes making up a great overture. Every note, every phrase and every chord must take its turn, carefully and accurately, to complete the masterpiece.

1 October 2010, LESTER SAM ARANETA GEROY MD MPH

This essay was written before Dr. Geroy left for London to study Masters in Health Policy, Planning and Financing (2010-2011).

He worked with Dr. Arturo M. Pesigan in 2008 to 2010 in WHO WPRO after three years of community work in Malaybalay City Health Office in Bukidnon (2005-2008). They worked together again in 2011 in WHO Kobe Center in Japan, and briefly in 2012 (Typhoon Sendong), 2013 (Typhoon Pablo and Typhoon Yolanda) and 2015 (Sri Lanka). Dr. Pesigan mentored many public health practitioners in the area of disasters and emergencies. We uphold great mentors and their influence in our professional growth in public health.

This article was partly sponsored by Dr. Allison Gocotano who also worked with Dr. Pesigan and Dr. Geroy for Typhoon Ondoy, Typhoon Sendong and Typhoon Yolanda. He continues to work on disasters and emergencies in other countries.

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Beyond the Clinical: Applying Systems Approach to Addressing Mental Health Issues during the Pandemic and Beyond Joffrey Sebastian E. Quiring, MD, EMSRHS, FPPA All of us feel the wrath of the COVID-19 pandemic. We grieve the many losses suffered - people, work, money, routines, certain freedom, time, and opportunities.

Most of us fear illness and death. There was a sudden shift to stricter hygiene and sanitation protocols for which we are not accustomed to. Physical distancing, restricted quarantine measures, and prolonged isolation especially for those who are ill, have also denied us the traditional ways of giving and receiving social support. Even spiritual and religious practices which are considered important ways of coping with the crisis, have been significantly altered.

The psychosocial impact of the pandemic, however, goes beyond the individual. Families have been confronted with the challenges of unemployment, economic difficulties, work-from-home set up, maintaining work-life balance, homeschooling and online learning, and dealing with domestic issues, including abuse and violence. Our communities are grappling to enforce COVID-19 protocols, provide basic services, and respond to other needs of its constituents. Vulnerable populations, including those with mental disorders, are even more marginalized.

With the growing burden on our healthcare system and the added stigma to and discrimination against health workers, our medical frontliners are at greater risk of experiencing burnout. Health services for non-COVID cases have been disrupted and patients have been more reluctant to seek face-to-face consults. Our national government, therefore, is hard-pressed to come up with a comprehensive, inclusive, evidence-based, and humane strategy to address the pandemic while continuing its other functions unhampered.

While we preach, “it is okay not to be okay,” recognizing that what most people manifest now are normal reactions to this very abnormal situation, we are also cognizant of the fact that another health crisis may be looming upon us.

The National Center for Mental Health has reported an increasing demand for its crisis hotline and telemental health services.[1] Among the common clinical

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conditions we psychiatrists encounter during pandemic are depression, anxiety, psychosomatic reactions, adjustment problems, trauma symptoms, and substance abuse. We have not even fully understood the biological effects of SARSCoV-2 on the brain. So far, there has been evidence of the virus causing neurological disorders (i.e. encephalitis and stroke), as well as persistent changes in mood and behavior.[2,3] Given all these circumstances, it seems inadequate to be content with incorporating telepsychiatry in our practice and give psychopharmacological or psychotherapeutic interventions to our patients. There is no more escaping the burden in addressing the “triple global public mental health challenge” of: (1) preventing the increase in mental disorders and the decline of mental well-being in the general population, (2) protecting people with pre-existing mental disorders from the consequences of COVID-19, and (3) providing support and interventions to health care workers and other frontline workers. [4] This may mean learning and unlearning some things and transcending personal challenges and our own resistance to change. Before the COVID-19 situation, the Philippine Psychiatric Association has already been challenging psychiatrists in the country to be L.E.A.D.E.R.S. - Leaders, Educators, Advocate, Diagnostician, Expert, Research, Social change agent.

Now, more than ever, the call is greater.

All this comes at a very opportune time.

The signing of the Implementing Rules and Regulations of the Mental Health Act in January 2019 paved the way for the establishment of the Philippine Council for Mental Health, which is laying down the groundwork in the areas of: (1) governance and leadership, (2) mental health information systems, (3) mental health services, (4) mental health promotio, (5) education, training, and capacity building, and (6) mental health research. Increasing insurance coverage for mental disorders, parallel with the implementation of the Universal Health Care Law, are now moving forward. It is inevitable that psychiatrists will be asked to participate, if not lead these initiatives.

Just as previous disasters have paved

the way to integrate mental health care in primary care, this pandemic allows us to look closely at our health system and help further the cause of mental health in the country. This could be a pivotal point in the practice of psychiatry in the Philippines!

But where do we begin?

We should continue to speak out. We ought to be heard beyond our clinics.

We should grab every opportunity to give psychoeducation and promote early detection of and interventions for mental disorders through various platforms.

We should put equal focus on wellness programs across the life stages (children, young people and students, parents, elderly) and for specific populations (school, workplace, health care workers, and marginalized groups). We should assert our expertise in explaining human behaviour during pandemics and informing risk communication efforts and humanitarian measures. We ought to share our research agenda and results to provide evidence-based solutions. We need to talk about scaling up services for the mentally ill and build capacities and infrastructures for mental health care, while adhering to safety protocols and ethical standards. More importantly, we ought to lobby for policies that address the social determinants of mental health (i.e. socioeconomic inequality, poor education, unemployment, among others) to create sustainable and longterm solutions.

COVID-19 has fast-tracked the efforts to promote mental-wellbeing and prevent mental disorders at the primary, secondary, and tertiary levels.[4] There are lots of things to do. Thankfully, psychiatrists cannot and should not do this alone. Key to the success is effective collaboration with the different stakeholders, starting with colleagues in the medical profession and public health experts. Doing a part of the big work is a good start. Creating more synergies to effect greater change is also another. It is high time to leverage on the opportunity this crisis brings. The COVID-19 strategy cannot exclude this work because truly there is “no health without mental health.”

References 1.

2.

3.

4.

Aguilar, K. (2020). NCMH sees growing anxiety, feelings of sadness among hotline callers. Inquirer.net 9 September, Accessed at https://newsinfo.inquirer.net/1333142/ ncmh-sees-growing-anxiety-feelings-ofsadness-among-callers-in-mental-healthhotline Ellul, M., Benjamin. L., Singh, B. et al. (2020).

Neurological associations of COVID-19. The Lancet Neurology 2 July, DOI:https://doi. org/10.1016/S1474-4422(20)30221-0 Rogers, J., Chesney, E., Oliver, D., et al.

(2020). Psychiatric and neuropsychiatric presentations associated with severe coronavirus infections: a systematic review and meta-analysis with comparison to the COVID-19 pandemic. The Lancet Psychiatry 18 May, DOI:https://doi.org/10.1016/S22150366(20)30203-0 Campion, J., Javed, A., Sartorius, N., et al. (2020). Addressing the public mental health challenge of COVID-19. The Lancet Psychiatry 9 June, DOI: 10.1016/S22150366(20)30240-6

Dr. Quiring is a faculty member of the UP-PGH Department of Psychiatry and Behavioral Medicine. He teaches social and community psychiatry and is part of the department’s Mental Health Policy, Advocacy, and Development (MHPAD) committee. He holds the degree of European Master in Sustainable Regional Health Systems from the Erasmus Mundus program.

Photo Credit Unsplash/Jude Beck

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Advancing Planetary Health for Climate Adaptation and Pandemic Prevention in the Philippines Renzo Guinto, MD DrPH Planetary health is a new integrated vision for the future of health of both people and the planet.

We now live in the Anthropocene epoch, in which human activities are the major drivers of global environmental change. In turn, these ecosystem alterations create new public health problems.

Two contemporary challenges at the heart of the human health-environment nexus are climate change and pandemics. Accelerating climate change leads to more typhoons, extreme heat, flooding, and sea level rise, which then generate a wide range of climate-related diseases such as mosquito-borne disease outbreaks, heat stroke, and hypertension due to intake of salinized water.

Meanwhile, unabated encroachment into natural ecosystems through wildlife consumption and rapid urbanization increases the likelihood of a zoonotic leap – when a virus jumps from an animal to a human being, which is how the ongoing COVID-19 pandemic originated.

The Philippines is at the heart of planetary health. A tropical developing country in Southeast Asia, the Philippines is one of world’s most climate-vulnerable countries and is also a known infectious disease hotspot. The Filipino people are now beginning to experience the early health consequences of climate change; hence, there is an urgent need to build the capacity of health systems and local communities to effectively respond to these emerging health conditions.

On the other hand, the lush Philippine environment is home to a rich biodiversity of microbes that can easily spread locally and even globally if community systems for habitat preservation and early outbreak detection are not put in place.

The planetary health story of the Filipino must be told. Despite the looming health crises brought about by long-term climate change and future pandemics, Filipinos remain a resilient and innovative people.

Initial efforts are already being undertaken by local governments, non-governmental organizations, private sector, and youth

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groups across the country to adapt to climate change as well as reduce the likelihood of the next epidemic. There is a need to gather all these stories from the frontlines and to share them so that the next generation can learn and use the lessons to reshape their future anew.

Voices PH is the first step towards planetary health renewal. Voices PH is a flagship project of PH Lab – a newlyestablished “glo-cal think-and-do tank” for advancing the health of people and planet. This project will be implemented in partnership with the East-West Center in Hawaii, USA and other local and international organizations. Voices PH is about listening to the voices of the Filipino people as they confront the climate crisis and prevent the next pandemic. It is also about amplifying these voices so that they are heard by communities in the Philippines and elsewhere – to help advance planetary health awareness and action.

Envisioned as a long-term project, Voices PH will have an initial phase with three major components – all happening in voices.ph website in tandem with other social media platforms. First is an educational campaign using films and blogs that capture today’s planetary health challenges and tell stories of community action. Second is a series of futures dialogues using online video meeting platforms to bridge scientists and communities and spark dynamic conversations about the future. Third is creative research using crowdsourced films and written narratives to document and analyze emerging planetary health impacts and adaptive responses by local communities.

The end goal: to make the Philippines the ‘silicon islands’ of planetary health innovation. Let us shape a positive blueprint for the Philippines’ climatesmart and post-pandemic future. The journey begins with Voices PH. Reach us at info@phlab.org.

Renzo Guinto, MD DrPH is Chief Planetary Doctor of PH Lab – a “glo-cal thinkand-do tank” for advancing the health of both people and the planet. Renzo is also an Obama Foundation Asia-Pacific Leader and Aspen Institute New Voices Fellow. Currently he is member of the Editorial Advisory Board of The Lancet Planetary Health; adviser to the Forum on Climate Change and Health of the World Innovation Summit for Health in Qatar; and Next Generation One Health Adviser of the Lancet One Health Commission hosted by the University of Oslo in Norway. Renzo received his Doctor of Public Health degree from Harvard University and Doctor of Medicine from the University of the Philippines Manila under the INTARMED Program. He is a pioneer member of the Philippine Society of Public Health Physicians.

Overcoming Borders Shirly Pador, MD, MPM Even when in between international missions, I always make sure to return to my beloved country, the Philippines.

I delve in public health practice under Alliance for Improving Health Outcomes and the Philippine Society for Public Health Physicians.

I had the best experience when I helped organize the first Public Health Convention (PHCON) in 2019 where I served as the Project Manager. Working with the right people along with a vibrant and conducive environment is a fulfilling experience.

Aside from organizing public health events, I also impart my experiences to future health practitioners.

I had the privilege to share my humanitarian and medical relief activities to medical students from University of the East Ramon Magsaysay Memorial Medical Center (UERMMMC) who were members of MedKom, a medical students’ organization interested in community medicine. I also had the chance to share the same in a medical school in Cebu City. I will never tire of sharing my advocacies and involvement in humanitarian and medical aid around the world. Though not as much as our western counterparts, there are a lot of Filipino health care workers who are involved in the same field of practice. It is my fervent hope that many more would follow suit. The public health perspectives I gained as a former Doctorto-the-Barrio, coupled with the theories from Masters in Public Management were immensely manifested as I work under the Medecins Sans Frontieres (MSF). As an expatriate staff, aside from clinical work, we are expected to manage people, capacitate the locals as part of sustainability measures, participate in planning and evaluation process, along with being mindful of the resources as well as security. I believe in uplifting the public health practice in our country, and ways to sustain such cause are to spend time and effort, do your best, and be passionate in every step of the way.

Photo Credit Regina Rosero MSF

Photo Credit Regina Rosero MSF

Photo Credit MSF

Photo Credit Regina Rosero MSF

Dr. Shirly Pador worked as a Doctor-to-the-Barrio in 2012 at Viga, Catanduanes. She first joined the MSF as a local staff during Typhoon Haiyan/Yolanda in Tanauan, Leyte. She also worked for a local NGO on a TB project before joining MSF again in 2018 as an international staff. Currently, she is assigned in South Sudan as the doctor for TB, HIV, and other infectious diseases building capacity of the local health force and ensuring sustainable infectious disease care for the community. Dr. Shirly advocates for equal access to quality health care for all regardless of race or social stature. She also encourages her peers to go into public health as an equally fulfilling path (other than clinical specialization).

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Moments with the Secretary General Lester Sam A. Geroy, MD, MPH, MSc-HPPF It was actually Dr Niko Cedicol (now Cultivare Editor-in-Chief) who first introduced me to Dr Joey Francis Hernandez in November 2017. They were classmates, roommates and good friends in medical school. I was looking for a Project Manager on a UNICEF-funded project with the Department of Health (DOH) and Physicians for Peace Philippines (PFPP) on Child Injury Prevention. Joey was fresh from the community then, a recent DTTB graduate, and decided to return to Manila to gain experiences at the national level.

It was perfect timing. January 2018, we hired Joey as Project Manager. In 7 March 2018, PSPHP became SEC-registered and we had to organize the First Lecture Series within a month (14 April 2018).

One of my early observations with Joey was that he can mobilize and command.

Within a month of working with my team, I observed that he was very comfortable in delegating work. This is a unique trait – other consultants and managers I worked with prefer to work on tasks themselves rather than assign them on others.

I guess Joey matched my personality as a Secretary General because he is comfortable with public visibility roles, while I preferred back-end work. Now, somebody can be emcee in the different events we organized in the Child Injury Project. He was also the main organizer and emcee during the first PSPHP Strategic Plan in July 2018. After the Strategic Planning, the Execom understood that if we wanted to move the different Strategic Objectives, we had to engage somebody to support its implementation. We had no better opportunity than to “promote” Joey from a Project Manager to the Secretary General. Hence, the Secretariat was born.

In September 2018, Paolo Encarnacion joined the team as the first Project Assistant.

Being publicly visible matched Joey’s fashion sense. I had always loved his brown-blue combinations, where leather and jeans meet. His hairstyle also has not changed. And my impression was that he was a guy who would save money so

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he could look good and travel. Ah, travel was his favourite part. And public health projects seemed to match that, except that he had to juggle between personal travels and official travels, which made things rather complicated. At one time, he traveled in about six European and African countries in six weeks straight, practically living off his luggage bag. That seemed terrible, at least to me.

Expert travelers contribute a lot to this world. I traveled to South Korea in July 2019 for the first time. When I arrived in Incheon Airport, it was also his departure.

We had a two-hour meeting dinner in one good Korean restaurant in the airport. For the record, we called Paolo E so we could have an online meeting of sorts.

My next big project with Joey was on Antimicrobial Resistance (AMR) National Action Plan for the Philippines. I saw it as a Filipino tribute to my 6-month assignment to develop the Multi-Sectoral Action Plan for Cambodia. Joey had a more technical role in this, and was able to do part of the research, interviews and writing, along with Project Management roles.

The project was with DOH through WHO support and project management by the Alliance for Improving Health Outcomes (AIHO).

As the first Secretary General, Joey has indeed been a witness in the early milestones of PSPHP. During the preparations and organization for the first PH Convention in 2019, Joey had already started to work with another firm. His time had become limited and could work mostly on weekends. That was when we brought in Dr Andrew Bucu and Dr Shirly Pador to help us in the PSPHP Secretariat.

I had the privilege to see many young public health colleagues during the transition of their careers. In Joey’s case, it was a transition from the community, back to Manila, to another organization, and finally into foreign masters. I had also worked with colleagues who came back from Masters abroad and finding their way and niche in the Philippine Health System. These transitions require a good amount of courage to take risks and focus on goals. I do hope that many more young colleagues would not be afraid to follow this path. And better now because there are more of us who can provide guidance, PSPHP as an umbrella that could be their home.

Joey rose into public attention when he became one of the early COVID-19 survivors. His symptoms started a few days after the first PH Safe Space organized to celebrate PSPHP’s second anniversary on 5 March 2020. It also brought all of us in the dinner in Makati to self-isolate

and check our health status. A few days after, we had an online meeting and Joey had started to complain his symptoms.

The next day, it went bad. I was in all prayers and occasionally checking on his health status. We were thankful when he got well. Being among the first doctors who survived, Joey almost immediately got coverage in many media companies including CNN Philippines.

The Society is growing. Soon, the Board of Trustees and Execom will change.

But we hope for a stronger Secretariat that would carry on the aspirations of those who pioneered the organization.

We would always remember people who shaped the organization when it had no form, and believed in it when everything was young and fragile. May this story be an inspiration to the next generation of young public health leaders and entrepreneurs to take risks and continue to believe what we had worked hard for.

Our success depends a lot on how we will work on it together (Opus), keeping our faith and values (Virtus) and enhancing our credibility (Scientia).

Dr Joey Francis Hernandez is the first Secretary General of the Philippine Society of Public Health Physicians (PSPHP). He is currently taking up Masters degree in Public Health in Johns Hopkins University through a Fulbright scholarship.

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Lessons this Pandemic is Teaching Us: MultiLevel Systems Resilience And Intelligence Helen Santiago-Sigua, MD, MHA, BFEF, DCOMM

This pandemic has already imprinted itself upon human beings’ psyche, creating fears, anxiety, and complicated grief for both citizens and leaders. The complexity of the psychological, social and spiritual nature of this stress cannot be fully understood by scientific reductionism and sophisticated thinking alone. Without yet fully comprehending the cause in terms of identification, time and locality of epicenter, it necessitates linking to questions of, in broad strokes, ecological sustainability and resilience. It drives us to rethink the intricate web of human-tonature interrelationships and dynamics that sparked this unprecedented crisis as well as our responses.

Resilience requires a holistic and integrated approach to this new public health adversity. People who can make a difference are those who see the big picture. This crisis has persisted for almost a year, and uncertainty and anxiety still abound. Ordinary citizens were brought to understanding scientific terminologies that used to be only in the vocabulary of epidemiologists. At the same time, it made us realize that science and technology and sophistication are only fragments of the solutions.

Asking the right questions In the resilience discourse (see table on methodological questions on resilience dialogues), the individual is perceived as being immersed in the resistance to overcome their limits regarding suffering, fear, anxiety, panic, loss of control, meaning and direction. On enlarging spheres, nations are perceived with smart and capable leadership for planning and implementing strategies for the mitigation of a hazard, while based on scientific interdisciplinarity and knowledge. In this articulation of resilience, it implies that disaster management must integrate natural and social capitals, ethics, and values as agencies.

To structure the discourse on resilience, we need to map it as frameworks of disaster, i.e. risk, hazard, vulnerability and exposure. The main pillars of resilience are the vulnerability and ability to deal

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Methodological questions for the resilience dialogue.

Source: Zabaniotou/ Global Transitions 2(2020).

with situations of extreme adversity.

Resilience is defined as the ability to anticipate, absorb, recover, and adapt to unexpected threats and overcome/ withstand adversity. Before efficiency, resiliency must first be present. Coping is a key component of the resilience process; moreover, it is a universal human activity and experience. The ability to deal with adversity (coping) is described as the set of strategies used by individuals to adapt to adverse or stressful circumstances. Adaptation is a complex concept that primarily refers to the limits to physical adaptation and sociopolitical or cultural adaptations. Mitigation is about reducing the causes of the hazard, while adaptation concerns adjustments to the consequences for ecosystems and human life.

The theoretical concepts we need to grasp on systemic resilience root down and run parallel with inner individual-level resilience: the systems view of life, unpredictability of environmental challenges, functional diversity, interconnectedness , ability to deal and adapt with insidious and acute de-equilibrating forces, and the natural trajectory to always seek equilibrium after the shock experience.

Resilience Meta-Frameworks Resilience is a multi-theoretical, interand trans-disciplinary high-order skill that has emerged from physics and engineering as the concept of elasticity in materials science. In psychology, the term resilience is defined as a cognitive and behavioral effort that runs as a

continuum across human life span. In biological sciences, we see this systemic resilience from the atomic, biochemical, cellular, histological and organ levels.

Neurolinguistics consider that there is no failure and that there is only a feedback of self-organizing systems seeking a state of balance and stability. Spiritual resilience is defined as the ability to sustain one’s sense of self and purpose through beliefs/ principles/ values whenever encountering adversity, stress, and trauma; conversely, coping shows a strong relationship with positive adaptive behaviors. Ecological resilience is defined as the persistence of relationships within a system and the ability of these systems to absorb changes, not only to thrive but to gain, grow, and attain progressive development and metamorphosis to better forms.

Resilience thinking runs parallel with dialectical thinking, which refers to the ability to view issues from multiple perspectives and to arrive at the most economical and reasonable reconciliation of seemingly contradictory data and postures. It entails credible dialogic communication, trusted leadership, collective consciousness, intuitive mindedness to handle uncertainties and things outside one’s control, the ability to reconcile scientific evidence with pragmatic innovations, eco-harmony, and ability to reflect on learnings, especially experiential ones. Through dialogical conversations, we hone our paths back to equilibrium.

Figure 1 teases out uncertainty as both objective and subjective, requiring differential yet intimately integrated response. Resilience starts with a self grounded on both moral transcendence and intuition, where there is uncertainty on the one end, and wraps up on the other end, intelligence, where things are predictable and data-driven (through modelling and research).

Intelligence Frameworks for Smart Leadership Like how we need smartphones and smart transport, we need smart leaders in these extraordinarily challenging times. Smart leadership ranges from contextual, moral, emotional, generative, technological and transformative.

Way Forward With pandemic resilience, navigate our way using both micro and macro lenses.

Deforestation and massive intrusions into other ecosystems have fragmented the self-regulating ecosystems and disrupted the web of life. The coronavirus and other viruses were living in symbiosis with certain animal species and now have jumped from those species over to humans. Stress comes naturally impacting all layers of our beings (biopsychosocio-spiritual); therefore, these are the same components and building blocks towards creation, development, and implementation of this resilience framework. Healing the planet is not unrelated to healing our own anxiety and pain and bodies because the pain of the earth and that of people are interdependent. Thus, the healing of our individual person’s suffering can become the basis of the healing of all the rest of the systems inside and outside of bodies, minds, and hearts. When we realize shared meaning and purpose for humanity, and navigate our way towards that, it is one step back to our new being, relating, and symbiotic co-existing.

Source: Tannert et al, 2007 Figure 1. Uncertainty affecting various mental decisions and proposals

Intelligence Frameworks for Smart Leadership

Source: World Economic Forum, 2020

Dr. Helen Sigua specializes in Health Communication, Healthcare Management, Family and Occupational Medicine, Mental and Behavioral Medicine, Mental Health Human Rights Law, Climate Change, Epidemiology, and Global Health.

Email: hssigua@up.edu.ph

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Aida A tribute to a Rural Health Midwife Juan Alfonso Leonardia, MD, MSc

Soon enough Manong Cano won Manang Aida’s heart and there they settled in the fishing village of Bagongon, where they raised two boys, owned a few fishing trawlers, and Manang Aida worked all her days as a Rural Health Midwife.

I would always stay over at their home, a warm and loving one, and I could tell in my heart that indeed the story of Manong Cano’s devotion for Manang Aida was true. I loved the fruit salad that she made mixed with fresh coconut shreds, corn kernels, and ground peanuts - a treat that I would always look forward to after an entire morning of consults. In between meals she would serve me snacks from her store, and whenever I would ask her if the barangay reimburses her for hosting me she would always say that they do, when in fact I suspect she spends out of her own kindness, only happy to have a doctor around to tend to her neighbors’ illnesses.

Manang Aida and Mang Cano during their son’s wedding in 2007

She was one of my favorite midwives in Concepcion. She smiled a lot, hardly ever spoke ill of anybody, and had a pure-hearted, child-like aura to her that betrayed her age. It would almost seem that she was blessed enough not to have seen enough hardships in her life to taint her soul with bitterness. But one could tell from the lines on her face that she’s had her fair share. I always imagined that it was because she saw the world in a brighter light than most, and this light was reflected in the warmth of her presence.

Despite her mild nature she was one of the most influential persons in her community, partly, I suspect, out of a deep respect for what she stands for, but even more so because she has helped so many in her life that one could not simply deny her request for a bit of their time to learn a bit more about health. She always drew quite a crowd when she called for a mothers’ class, and I could not help but admire how she did it with minimal coaxing and her disarming smile.

In my two years as a doctor in Concepcion, it was Bagongon that I visited the most because Manang Aida was always generous and willing to have me around. I could still vividly recall the wait for Manong Cano, her husband, to pick me up at the port the locals call “Talisay” because it was marked by a great old tree of the same name, driving his motorized outrigger boat, the only one of its size with a plexiglass windshield in the entire town - supposedly specially built to keep his dear Aida from getting wet. Their love for each other was the talk of the town. It was said that when Manang Aida first came to Concepcion, she was quite a catch being a lovely single professional health worker, while Manong Cano, whom one can clearly tell even at his age where he got his nickname, had his own following of admirers.

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Bagongon wasn’t the most beautiful of the island villages, but I loved going there because I had all the comforts provided

by Manang Aida and her family. Since there wasn’t much to do in the island, I would spend evenings listen to the stories of how they came to settle in that island and the glory days of fishing. It was one of those moments that I felt how it was to be truly free from the desire to surround oneself with life’s luxuries. Unknowingly, by living her own simple life, Manang Aida had been instrumental in my own pursuit of happiness.

About a year after I last set foot on Bagongon’s shore, I received news that Manang Aida was riding a passenger boat on her way to the Main Health Center, when a sudden storm caught them at sea and capsized the vessel. Unfortunately, Manang Aida who lived half her life by the sea did not know how to swim. Many would say that the Doctors-to-the-Barrios are today’s heroes, but for a Doctor-to-theBarrio, rural health midwives as dedicated and as giving as Manang Aida are the real heroes – the wind beneath our wings.

Why I am a Public Health Academic Jaifred Christian F. Lopez, MD, MPM Life in the academe at first glance can be just like any other job; one gets involved in a rat race with the aim to climb up the career ladder. Not to mention the privilege to brandish one’s fancy academic attire year after year during commencement. I soon realized that this was not just what the academe is all about. Now, more than five years since I chose this career track, I now fathom the immense importance of the academe.

As part of the World Health Summit Young Physician Leaders 2019, Berlin, Germany

My volunteering days in Gawad Kalinga Taguig, 2015

In my past work as a Municipal Health Officer, I aimed to solve public health problems while looking at the context of my clientele: their culture, their socioeconomic concerns, and their collective aspirations. There are just so many problems though, and this warrants a systematic way of dealing with them. In this system, many implementors would be wont to say: As long as our scorecard wasn’t red in this indicator, I’m OK. As long as I’m not rock bottom in my province, I’m OK. As long as I don’t have any maternal or neonatal death in my jurisdiction, I’m OK.

My days as a Doctor to the Barrio, 2013, Sablan, Benguet

My days as a Doctor to the Barrio, 2013, Sablan, Benguet

But does this lead to achieving the “best possible state of health?” We may need to dig deeper to know what will work.

With the PSPHP, 2017, after the First Board Election

As part of the Healthcare and Social Media Summit Organizers, 2019, Cebu City

Being part of the academe entails making sense of current and emerging trends in my field of endeavor, and catalyzing discussion on how to solve the problems of the world today. To respond to real world needs, we academics write the ideas brought forth by deep introspection and analysis of the problems set before us. We challenge norms and paradigms, allowing us to zoom out of conventional ways of solving problems, and propose suitable solutions.

I felt that approaching health problems from an academic standpoint would enable me to zoom out, and investigate approaches that would truly produce the best possible health. This requires me to do research that will facilitate innovation and build on good practice. This also requires me to listen to what frontliners experience, so the solutions I devise are truly helpful.

This is why I chose to be in the academe. I believe in health for all, and I want to be at the forefront of how it is to truly achieve it.

(With excerpts of “Academe and Public Health”, originally published at jimlopez875.wordpress.com, 10 June 2017)

Dr. Jaifred C. F. Lopez (Jim) is founding board member and treasurer of the Philippine Society of Public Health Physicians. He is Assistant Professor and Special Assistant to the Dean at the College of Public Health, University of the Philippines Manila.

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A Heartfelt Advocacy: Pediatric Palliative Care Marianne Joy Naria-Maritana, MD and Jerry V. Pua, MD

I was once asked the question, “Why Palliative care in Children? Aren’t children supposed to live?” My answer at that time was, “Yes. I wanted them to live the way children should, despite the challenges they are encountering.”

Cancers and chronic illnesses are devastating life-long diseases. It not only strips down a person’s physical body but also afflicts the spirit, faith as well as courage and hope in someone’s humanity.

It transforms someone from being human to being a disease entity. Now imagine it afflicting children, it would not only break the child’s youth and heart but everyone around him/her. Despite the complex treatment, it can be made bearable and worth the battle if we blanket it with Palliative Care.

Pediatric Palliative Care (PPC) is defined as an active total care of the child’s body, mind and spirit while also giving support to their families [1] from the point of diagnosis or recognition throughout a child’s life and death [2]. It embraces the physical, emotional, social and spiritual elements and focuses on enhancing the quality of life for the children and support for the family. Pediatric Palliative Care includes preventing, identifying and treating suffering among children with serious illnesses, their families and the healthcare team and professionals that care for them [3]. In this field of practice, a patient should not be seen as a mere disease entity but instead, considered as special with needs that when addressed, greatly strengthen them as well as the people around making that child feel like they are living a normal life. Palliative care does not mask the negative aspects of diseases or the situation but works around it, hence giving a silver lining to patients who are suffering.

Children are not little adults. This makes pediatric palliative care unique as it also focuses on disease impacts on growth and development or vice versa. It also involves age-appropriate communication skills and management strategies thereby

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Philippine Delegates for Fellowship in Palliative Care 2020 at Institute of Palliative Medicine, Kerala, India. From L to R: Dr. Masecampo-Pamplona, Dr. Siangho (Palliative Care Specialists), Dr. Torre-Fofue, Dr. Pua, Dr. Gentica (Pediatricians), Dr. Santiago (Family Medicine Specialist), Dr. Naria-Maritana and Dr. Uyvico (Pediatricians)

Photo with Aedan Pio Malvar and Dr. Naria-Maritana. (with consent from the mother).

Dr. Jerry Pua is a fellow-in-training in the field of Hematology and Oncology at the Philippine Children’s Medical Center. Dr. Marianne Joy Naria-Maritana is a fellow-in-training in the field of Ambulatory Pediatrics at Philippine General Hospital.

individualizing every action and empowering the already resilient nature of children. All these justify the fact that no same experience can dictate the outcome for other patients. As a family-centered approach is applied, the involvement of the entire family in providing treatment and care is crucial as well as their understanding of the situation, traditions, values and culture. This creates bond between treatment approaches and family time considerations and not just plain listing down of medications to relieve symptoms. Especially with the presence of family members around the patient, relief and inner peace is achieved by the child as these are the people who understand and provide care in its truest sense. The healing of the child, therefore is considered a family affair rather than a family burden, and once patients are in remission from illness, it is considered a big “win” more than just a “relief” from a tiresome dilemma.

With these, it also empowers the family to see the child’s illness as an advocacy rather than an adversary. Pediatric Palliative Care is not shying away from medicine but instead making medicine more manageable for the child along with strengthened support from the family.

Pediatric Palliative Care also applies to those with life threatening illnesses (e.g. neurologic and genetic conditions) as well as those children with chronic kidney diseases who decided to stop dialysis and have no venous access for catheterization, those children with heart anomalies whose surgeries are high risk, or with no options for surgery; and those afflicted with HIV, MDRTB and Malnutrition. We believe that pediatric palliative care is not an end to the means but rather a way to deal with the means, as it is another layer of perspective to approach a child with a disease that comes along with directed treatment. It is a holistic approach of treating a child with an illness.

Several institutions and families have reported that Pediatric Palliative Care contributes to improvement of symptoms, outcomes and quality of life. It also promotes good emotional well-being and improves family satisfaction. It has an overall impact on achieving the mission set forth by health providers under our present health care system.

We were taught at the Institute of Palliative Medicine, Kerala, India, that Palliative Care is everybody’s business.

Each person in the community plays a role to alleviate pain and suffering for those with life threatening illnesses.

It is our heartfelt advocacy that our fellow doctors, and other healthcare professionals would work hand in hand in providing holistic care, detecting and referring to palliative care specialists so that patients especially children and their families get the quality of life they deserve. We are advocates for Pediatric Palliative Care for the Filipino Children and Families.

“Pediatric Palliative Care no longer means helping children die well, It means helping children and their families to live well and then, when the time is certain, to help them die gently.” -Mattie Stepanek, 1990-2004 References 1.

2.

3.

Textbook of Interdisciplinary Palliative Care Association for Children with Life-threatening iseases Education and Pediatrics and End-of-Life Care (EPEC) Pediatrics

COVID-19: An impetus for a ‘Philippine Centers for Disease Control and Prevention’ Jason Alacapa, MD and Miguel Salazar, MD The COVID-19 pandemic, a novel respiratory viral infection originating from China but spreading rapidly across the world, has exposed loopholes in the Philippine health system’s disease intelligence, public health informatics, and epidemic response (1). The country is well-prepared for natural hazards through its experience with multiple typhoons, earthquakes, and floods affecting the country every year (2). However, COVID-19 has caught the Government of the Philippines off guard, especially the Department of Health (DOH).

Despite the increasing threats of climate change, environmental degradation, antimicrobial resistance, and under-regulated animal food production (3), preparedness against zoonotic disease transmission and emerging and re-emerging diseases has not been given ample support within the DOH. Recent outbreaks of seemingly controlled infections, such as measles and polio, preceding the COVID19 pandemic (4,5), may be leading symptoms of this long standing inadequate response. The landmark 2018 Universal Health Care (UHC) Law could have been a prime opportunity to increase budget allocation, but unfortunately, epidemic preparedness has been left at the wayside, as evidenced by the diminishing budget of the DOH Epidemiology Bureau (EB) (6), which should be leading disease surveillance. After all, budget allocation is a concrete manifestation of political will. The absence (or the lack thereof) suggests otherwise.

Fragmentation in various epidemic response responsibilities may have resulted in ineffective responses and confusion in accountability. Emerging and re-emerging infectious diseases is merely a program under the DOH (7). The EB, on the other hand, has been focused on providing reports of health statistics, disease surveillance, and health facility data of the Philippines every year.

Knowledge management and information technology are under a separate service. The Bureau of Quarantine (BoQ), although logically an implementing arm of the EB or the Disease Control and Prevention Bureau (DCPB), is part of the regulations team of the DOH and not the public health services team in which the EB, Health Emergency Management Bureau, DCPB, and Health Promotions and Communication Service (HPCS) are part of. Furthermore, laboratory testing expertise and infectious disease research are housed in a DOH research facility, the Research Institute of Tropical Medicine, physically located in a separate facility (8,9). These functional and geographic silos made it challenging to create a coherent strategy to test, trace, isolate, and treat the population to combat COVID-19. These units have been existing for several years, but the pandemic policy and strategy development has only been assigned to particular offices without integrating the critical skills needed across groups within the ministry. Worse, this apparent lack of vertical and horizontal integration of these silos may have contributed to role confusion and thus diluted accountability.

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Successful disease control, covering infectious and noncommunicable diseases, requires knowledge, attitudes, and skills from multi-disciplinary teams beyond medicine and public health.

Disciplines may include, but are not limited to, data science, decision and risk science, and social and behavioral change communication. The Centers for Disease Control and Prevention (CDC) model of the United States (US) may be a viable option for the Philippines to emulate. The US CDC is a federal government agency under the Department of Health and Human Services (10). Its main offices with their corresponding centers are Public Health Service and Implementation Science, Public Health Science and Surveillance, Non-Infectious Diseases, Infectious Diseases, and National Institute for Occupational Safety and Health. Other departments under the CDC Director are focused on areas such as strategy and operations, communications, policy, and laboratory science (11). Having this umbrella institution aligns every stakeholder to an overall strategy, harnesses synergies across fields, and minimizes unnecessary redundancies.

COVID-19 has shown that having a dedicated agency for disease control can improve response to epidemics. The Republic of Korea (South Korea) and the Republic of China (Taiwan) have vibrant Centers for Disease Control and Prevention, taking the lead in public health in their respective countries. South Korea has tackled COVID-19 through a science-based approach using homegrown technology to test and trace its population. With the country having a fully functional universal health care system, isolation, and treatment for their population was made possible.

This has also allowed their economy to open up early on in the pandemic (12,13). On the other hand, Taiwan has also harnessed the use of technology and an established emergency operation center system to act quickly to the threat of COVID-19. Through their National Health Command Center, Taiwan sent investigators to China to see the extent of the outbreak in early January. They then activated the Central Epidemic Command Center to lead the response efforts and coordination with other agencies across the government. Using their comprehensive national health insurance and immigration databases, they were able to monitor their population for possible cluster outbreaks and incoming COVID-19 positive cases (14).

One main strategy adopted by the Philippines, being a brainchild of the US CDC, is the Integrated Disease Surveillance and Response (IDSR) system. The concept of IDSR was first implemented in the African region through the support of the US CDC. ISDR aims to make data from surveillance from both health facilities and laboratories available to decision-makers for improved detection and response efforts for illnesses causing morbidity and mortality (15). The Philippine IDSR or PIDSR introduces a framework for public health surveillance in the country, which has six main activities, namely, detection, registration, reporting, confirmation, analysis, and feedback. This framework involves the following agencies within the DOH - EB, BoQ, DCPB, HEMB, and DOH regional offices. This framework also involves the municipal and provincial government units, as well as PhilHealth (16). However, even with the framework in place, there is no dedicated overarching institution, aside from the DOH, taking stewardship roles of disease control espoused by PIDSR. Indeed, having a system in place is only half of the battle. This gargantuan task of epidemic control needs strong top-down leadership and change management to mount an effective and agile epidemic response.

The Philippines is on the right track with House Bill No. 6096, “An act of creating the Center for Disease Control and Prevention, providing mechanisms for epidemic control, and other purposes,” filed by Representative Joey Salceda in January 2020. The Bill aims to bring in under the PCDC the following units: the HEMB, the EB, the DCPB, the RITM, and the BoQ (17). Indeed, this pandemic opens 68 a “policy window” in which the problem, the solution, and

politics converge. Such policy suggestion is urgently needed, but unfortunately, since this was filed under the heels of the COVID-19 outbreak, its focus has been limited only to infectious diseases. The Philippine CDC (PCDC) should be able to respond to any disease regardless of origin, namely infectious, non-infectious, environmental, or occupational. Additionally, the creation of the PCDC should also align with the UHC efforts since health security hinges not only on detection and response but also on the population’s ability to access safe, quality, and appropriate curative and preventive health services.

The role of other key stakeholders should not also be overlooked. Aside from the DOH and its attached agencies, the Department of Science and Technology (DOST), the University of the Philippines-National Institutes for Health (UP-NIH), the academia (such as University of the Philippines-College of Public Health), the professional societies (such as the Philippine Society of Public Health Physicians), and the civil society should collectively push for the agenda through research and advocacy. With a louder bottom-up clamor from the grassroots, coupled with the top-down policy instrument mentioned earlier, realizing a shared vision of an integrated epidemic intelligence and response may be happening sooner than later.

The COVID-19 pandemic is far from over; however, it continues to expose the cracks within the Philippine health system. Fragmentation and silos within the ministry of health and its attached agencies may have magnified the country’s weak disease intelligence and response. Moving forward, these hard lessons should serve as a wake-up call and an impetus for the government to establish its own integrated response - through a Philippine Centers for Disease Control. The country cannot wait for another epidemic to happen and lose thousands, or even millions, of lives which could have been minimized, if not totally avoided in the first place.

References 1.

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Amit AML, Pepito VCF, Dayrit MM. Lessons learned during the early phase of the COVID-19 pandemic in the Philippines. West Pacific Surveill Response J [Internet]. 2020;11(5). Available from: https://ojs. wpro.who.int/ojs/index.php/wpsar/pages/view/covid19-pre-print Banwell N, Montoya J, Opeña M, IJsselmuiden C, Law R, Rutherford S, et al. Developing the Philippines as a Global Hub for Disaster Risk Reduction - A Health Research Initiative as Presented at the 10th Philippine National Health Research System Week Celebration. PLOS Curr Disasters [Internet]. 2016;1–9. Available from: http://currents. plos.org/disasters/?p=32181 Whitmee S, Haines A, Beyrer C, Boltz F, Capon AG, de Souza Dias BF, et al. Safeguarding human health in the Anthropocene epoch: report of The Rockefeller Foundation–Lancet Commission on planetary health.

Lancet [Internet]. 2015;6736(15). Available from: http://linkinghub. elsevier.com/retrieve/pii/S0140673615609011 World Health Organization. Polio outbreak in the Philippines [Internet]. 2019 [cited 2020 Aug 31]. Available from: https://www. who.int/westernpacific/emergencies/polio-outbreak-in-thephilippines World Health Organization. Questions and answers on the measles outbreak in the Philippines [Internet]. 2019 [cited 2020 Aug 31].

Available from: https://www.who.int/philippines/news/featurestories/detail/questions-and-answers-on-the-measles-outbreak-inthe-philippines Parrocha A. Up to DOH to seek higher 2021 budget: Nograles [Internet]. Philippine News Agency. 2020 [cited 2020 Aug 28].

Available from: https://www.pna.gov.ph/articles/1092922 Department of Health Philippines. Emerging and Re-emerging Infectious Disease Program [Internet]. 2020 [cited 2020 Aug 28].

Available from: https://www.doh.gov.ph/emerging-and-re-emerginginfectious-disease-program Research Institute for Tropical Medicine. About us [Internet]. 2020 [cited 2020 Aug 29]. Available from: http://ritm.gov.ph/about-us/ history-vision-mission/ Department of Health Philippines. DOH Organizational Chart [Internet]. 2020 [cited 2020 Aug 19]. Available from: https://www. doh.gov.ph/DOH_organizational_chart Wikipedia. Centers for Disease Control and Prevention [Internet].

2020 [cited 2020 Aug 29]. Available from: https://en.wikipedia.org/ wiki/Centers_for_Disease_Control_and_Prevention Centers for Disease Control and Prevention (US). CDC Organization Chart [Internet]. 2020 [cited 2020 Aug 28]. Available from: https:// www.cdc.gov/about/organization/cio.htm Chung D, Soh HS. Korea’s response to COVID-19: Early lessons in tackling the pandemic [Internet]. World Bank Blogs: East Asia & Pacific on the Rise. 2020 [cited 2020 May 14]. Available from: https:// blogs.worldbank.org/eastasiapacific/koreas-response-covid-19-earlylessons-tackling-pandemic Kwon S. COVID-19: Lessons from South Korea [Internet]. Health Systems Global. 2020 [cited 2020 May 14]. Available from: https:// www.healthsystemsglobal.org/blog/406/COVID-19-Lessons-fromSouth-Korea.html Wang CJ, Ng CY, Brook RH. Response to COVID-19 in Taiwan. JAMA - J Am Med Assoc [Internet]. 2020;9–10. Available from: https:// jamanetwork.com/journals/jama/fullarticle/2762689 Centers for Disease Control and Prevention (US). Integrated Disease Surveillance and Response (IDSR) [Internet]. 2020. [cited 2020 Aug 31]. Available from: https://www.cdc.gov/globalhealth/ healthprotection/idsr/index.html Department of Health Philippines. Manual of Procedures for the Philippine Integrated Disease Surveillance and Response. 3rd ed. Vol. 1.

Manila: Department of Health Philippines; 2014.

Salceda J. House Bill 6096: An Act Creating the Center for Disease Control and Prevention, Providing Mechanisms for Epidemic Control, and for other Purposes. Philippines; 2020.

Dr. Jason Alacapa and Dr. Miguel Salazar are members of the PSPHP Technical and Policy Committee. The authors acknowledge the support of Dr. Lester Geroy in reviewing the article. We appreciate comments and feedback through the PSPHP Secretariat at psphpofficial@gmail.com.

Dr. Alacapa and Dr. Salazar are the co-convenors of Leading Evidence-based Actions through Data Science (LEADS) for Health Security and Resilience (L4H), a consortium of public health and data science professionals formed through the support of PSPHP. Dr. Salazar is the COO of Living Life Well Integrative Medical Group Inc., and the Health Systems Lead of NanayCare, Inc. He is a current doctoral student at University of Heidelberg’s Institute of Global Health. On the other hand, Dr. Alacapa is the CEO and Co-founder of Innovations for Community Health, Inc. (focusing on PPPs, market reforms, and health systems innovations for TB), and metaHealth Insights and Innovations, Inc. (the Philippines’ first HTA focused consulting firm in the country). He is currently a DrPH in Implementation Student at the Johns Hopkins Bloomberg School of Public Health.

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Strengthening Community Health Care Luisito L. Ruiz, MD, MSHSM

The core of our program is to establish a relationship centered towards caring which is an art of cultivating relations between doctors and the services they provide for their patients. It is about building that connection with the patients so that they can entrust us with their health. Our clinics give the assurance that they will receive a very thorough care program ranging from health promotion and prevention, treatment, rehabilitation, and palliative care. From this, an exceptional referral system can be developed as well as health education programs. Our services cater to the needs of our patients on almost every aspect and continuum of care.

With the introduction of the universal healthcare system by the national government, community-based primary care centers have revolutionized the notion of giving our countrymen access to affordable healthcare without compromising quality care. The collaborative efforts of the medical sectors and government can lead to a healthcare system that is efficient, accessible, and affordable for the general public.

We believe that establishing a well-equipped community primary care center is essential for the proper implementation of health programs of our country. Through this way, quality healthcare becomes more accessible for the public. It can reduce hospitalizations, treatment costs, and disease-related complications.

Every Filipino deserves quality healthcare that is accessible for everyone. Primary care centers can serve as the venue to promote full participation of the community so we, as doctors, can be with them every step of the way.

PBMEd Doctors Clinic is a multi-specialty and diagnostic clinic which serves patients day to day. They offer a full-service, multi-specialty clinic with competent and compassionate health professionals and affordable quality services. With more than 20 years of service to the community, the clinic have earned the trust and hearts of people from all walks of life. They are the trusted brand of community-clinics in the Philippines.

Dr. Luisito Ruiz is a practicing surgeon and is the Chairperson of the Philippine Society of Public Health Physicians. He has Masters degree in Health System Management.

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Developing Leadership in Complexity: Early Lessons of ZFF- Engaged Provinces from COVID-19 Pandemic Angeli A. Comia, MD, MPM

News of a new strain of coronavirus spreading in Wuhan, China, and other countries in December 2019 seemed insufficient to move the Philippine government to define a set of actions to combat what would turn out to be a worldwide pandemic.

Unsurprisingly, the country was caught flat-footed when the local transmission of COVID-19 was finally recorded on March 9, 2020. The country had its first imported case as early as January. For three provinces, however, health system reforms that began in 2016 allowed a quick, collaborative, and evidencebased management of COVID-19.

Before the COVID-19 pandemic, the provinces of Agusan del Sur, Aklan, and Bataan had been actively engaged by the Zuellig Family Foundation (ZFF) for its Integrated Provincial Health Systems and Development Program (IPHSDP) that began in April 2019. It was aimed at helping the three provinces transform their health systems into province-wide health systems as called for under the Universal Health Care Act of 2019.

create a ZFF team dedicated to the pandemic response. The ZFF Pandemic Response Framework was created. It contains evidence-based leadership and governance mechanisms for promotive, preventive, curative, and rehabilitative care. It served as a critical guidepost for the provincial health leaders as they resolve the volatile, uncertain, complex, and ambiguous (VUCA) situation brought about by the COVID-19 pandemic.

When the threat of COVID-19 became imminent, the three provincial governments (PHOs) were quick to respond. Being part of ZFF since 2016 meant these provinces had established expanded provincial health boards (PHB) that regularly met. This allowed the provinces to quickly convene their PHBs, issue relevant executive orders such as the creation of a special COVID-19 Task Force, and activation of command centers to prevent and control its transmission in their respective localities down to the barangay through the Barangay Health Emergency Response Teams (BHERTs).

The strict enforcement of community quarantine limited some of ZFF’s important onsite engagements with the provinces, but it led to a stronger and deeper relationship and communication with the provincial leaders through effective virtual platforms such as Zoom and Facebook. Practicing the “learning by doing” theory, the provinces were assisted in initiating pandemic risk assessment using the existing World Health Organization toolkit to determine the functionality and preparedness of the provincial government.

As health bridging headers of ZFF, they responded with urgency and gathered all their critical stakeholders from health and non-health sectors to commit to the goal of preventing COVID-19 transmission and deaths in their communities.

Within the Foundation, there was recognition of the serious disruptions COVID-19 could bring to the provincial health systems; thus, the decision to

Zuellig Family Foundation with Provincial Governors, Provincial Health Officers and DOH Regional PDOHOs engaged under the Integrated Provincial Health System and Development Program (IPHSDP), August 2019

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Since the provinces have different contexts, ZFF conducted a series of executive sessions to discuss their local COVID-19 situation including initiatives, challenges, and needed response. ZFF provided epidemiological projections vis-à-vis their existing data to help them identify evidence-based action points that can be immediately applied and customized to their context and keep the virus’ reproductive rate less than 1 (R0 < 1).

Since the duration to flatten the curve is indefinite and resources are limited, regular coaching and mentoring sessions with various experts were conducted with the governors and their COVID-19 task force for the four key LGU interventions of (1) strengthening risk communication, (2) strengthening real-time monitoring and testing with quick turnaround time, (3) improving surge capacity, and (4) protecting frontline workers.

As a result, the three provinces were able to enhance their comprehensive COVID-19 plans with corresponding fund re-alignments that prioritize sustaining regular health services, responding to health emergencies, and food and socioeconomic security.

ZFF Leadership and Governance Pandemic Response Framework to Address COVID-19

ZFF donated PPE sets, thermal scanners, assorted medicines, 2 units of mechanical ventilators, 1 year free subscription to Zoom platform and 1 unit of RT-PCR machine to every province engaged in IPHSDP.

LIGTAS COVID Center in Prosperidad, Agusan del Sur which is a recipient of the CBMC training of ZFF with PSPHP and AIHO.

ZFF funded the pilot rollout of the Community-Based Management for COVID-19 (CBMC) modules by the Philippine Society of Public Health Physicians (PSPHP) and Alliance for Health Outcomes (AIHO) from April to May 2020.

The target participants from the province, municipal/city, and barangay levels of Agusan del Sur, Aklan, and Bataan were assessed, oriented, and imparted with the CBMC toolkitâ&#x20AC;&#x2122;s four-point strategies on preparedness and response, case finding and contact tracing, establishing community isolation units and providing guidance to families in preventing and managing COVID-19. One mayor from Agusan del Sur even attributed the immediate completion and accreditation of their LIGTAS COVID Center from the recommended floor plan cited in the third module of CBMC. With the various packages of technical assistance and coaching support from ZFF, the leaders of the three provinces were able to identify and strengthen the

weak points of their health systems. The Learning Series held last June 30, 2020, enabled the governors and PHOs to share the quick wins and innovations of their pandemic preparedness and management response. They continue to be proactive in fortifying their border controls, enhancing their risk communication strategies, upgrading their testing and isolation facilities, empowering their BHERTS, and digitizing their contact tracing and mobile apps for contactless services and transactions. They have realized the value of a functional service delivery network and the need to sustain it for the subsequent integration of their provincewide health systems for Universal Health Care (UHC).

According to the PHO of Agusan del Sur, Dr. Jacqueline Momville, they may not be ready for this pandemic but it also brought out the best in them in terms of leadership agility and resilience. They become better versions of themselves every single day of the crisis as they hurdled the challenges

Prosperidad LIGTAS COVID Center

in collaboration with different sectors and human resources of multidisciplinary capacities. The key health leaders of the provinces of Agusan del Sur, Aklan, and Bataan expressed their deep appreciation for the partnership with ZFF. Since COVID-19 has taught every nation that it knows no race, age, religion, culture, or ideology, ZFF, as a catalyst, reminded the three committed provinces what leadership competencies must be exemplified: sharing information, intersectoral collaboration, and coordination across borders to survive this pandemic and bounce forward to the new normal.

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Addressing Infertility in the Philippines Sheila Mae Jallorina-Poulain, MBHARE, PhD (c) “Marami sa atin ang kulang sa edukasyon patungkol sa pertilidad. Huwag tayong mahiyang magtanong tungkol sa tamang impormasyon. Bawat isa sa atin ay may pagkakataong tuparin ang ating pangarap na magkaanak sa tamang pag-gabay.”

Not having children, especially beyond one’s biological clock, has made not only women but also couples exponentially anxious and borderline hopeless. Fertility rates, or the number of children delivered by women and borne from the union of men and women, have decreased globally.

During the 50s, global fertility rates were at 4.96 children per woman, but now it has only reached 2.52; the Philippines has relatively the same rate at 2.6.

According to Worldometers.info though, it has plunged way too low from around 8% more than half a century ago.[1,2,3] This means that despite the ballooning population of 100 million Filipinos, we are suffering from infertility, and only a few have access to fertility education and can afford fertility health care.

Fertility is a public health concern. It is not only an issue about choices; it is also an issue of chances. Because the Philippines remains economically challenged and predominantly Catholic (shunning premarital sex or reproductive measures), many women are delaying having children even as late as age 30 in order to finish school, have a career, travel, and enjoy the lifestyle choices arising from women liberation and independence. As a result, the challenge of finding a partner who is equally ready to have a baby is a major stumbling block. Thanks to the medical breakthrough of assisted reproductive technology, consenting parents can choose to freeze their own egg and sperm to conceive at a later time. Among women who have opted to freeze their eggs, the majority are ready to have a child but they have just not found a suitable partner.

Many Filipinos do not yet understand the causes of declining fertility. As a matter of fact, Filipinos are not very vocal or open to discussing infertility problems.

Fertility is perceived as a personal issue to Filipinos due to our close-knit familial orientation and religious background.

Azelene Williams [4] once said that “The children we bring into the world are small replicas of ourselves and our husbands; the pride and joy of grandfathers and grandmothers. We dream of being mothers, and for most of us those dreams

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are realized naturally – for this is the miracle of life.” Not having a child of your own is not only a woman’s issue, it is also a husband’s issue, a grandparents’ issue, or a family issue. However, according to the World Health Organization, infertility care is probably the most neglected and underestimated health care issue [5,6].

WHO considers childless couples as a silent population who may suffer from emotional crises of shock, denial, anger, isolation, guilt and grief. We may be unknowingly oblivious to their quiet sobs, excruciating pains, and difficult struggles when we can actually extend help through emotional support and sharing correct information on how to address their infertility issues.

The chance of getting pregnant under age 30 is about 20% each month, but this drops to about 5% at age 40.[7] There is an increased risk of miscarriage and certain conditions in the offspring, such as autism, when the male partner is over the age of 45.[8] Pregnancy is only possible from about five days before and through the day of ovulation – the fertile window.

Most people get pregnant within a year of trying, but for those who do not, they may need help sooner rather than later. Women over 35 should see a health professional if they have not gotten pregnant after 6 months of trying. These scientific facts have prompted embryologists and fertility world leaders to call for a universal action on fertility education. Countries such as the United Kingdom, Australia, Canada, Sweden, Denmark and Portugal have come together and initiated a global fertility education campaign.

Dr. Joyce Harper founded the International Fertility Education Initiative which aims to improve fertility and reproductive health awareness through education. As part of this group, I have had the honor to have contributed to translating the

organization’s awareness posters to Tagalog and these have been approved for circulation to rally wider support in the Philippine health sector and to ultimately touch base with aspiring Filipino parents.

Because of cultures and traditions, the inability to procreate has often not been included among top priority health concerns in many developing nations like the Philippines. As a result, I started Pinoy Fertility Health which aims to increase awareness and access to fertility education through social media sites.

Through our online channels, Filipinos can research and follow different topics on how to manage fertility health especially for situations where primary prevention of infertility is feasible.

Pinoy Fertility Health is a public health strategy focused on reducing the prevalence of infertility, improving fertility health and quality of life of every Filipino, and averting the costs of infertility treatment including the downstream costs arising from adverse outcomes of treatment on couples and children. With this advocacy, the goal of Pinoy Fertility Health is to have a fertility education website and also introduce statutory fertility education in schools to engage young people in their fertility future.

With proper education, hopeful parents have the chance to conceive their own children before it is too late. Pinoy Fertility Health aims to preserve fertility and in the long term prevent infertility in young people.

Tell us why you think fertility education is important and what province you are from – this is a global project and we want the Philippines to be well-represented. If you have fertility concerns, please follow and message us @pinoy_fertilityhealth on Instagram and Facebook or tag us through #pinoyfertilityhealth.

Pinoy Fertility Health is a public health strategy started by Dr. Jallorina. It promotes fertility education using web-based platforms to reach and engage more Filipinos in the hopes of preserving fertility and the future.

References 1.

2.

3.

4.

5.

6.

7.

8.

Harper, J. (2019). Launch of a global fertility education poster campaign.

Available online at http://www. globalwomenconnected.com/2019/10/ fertility_ed/ Macrotrends. Philippines Fertility Rate 1950-2020, United Nations-World Population Prospects. Available online at https://www.macrotrends.net/ countries/PHL/philippines/fertilityrate’>Philippines Fertility Rate 19502020</a>. www.macrotrends.net.

Retrieved 2020-09-05.

Worldometer. Philippine Demographics.

Available online at https://www. worldometers.info/demographics/ philippines-demographics/ Williams, A., 2012. Infertility, Road to Hell and Back.

World Health Organization. Infertility is a global public health issue. Available online at https://www.who.int/ reproductivehealth/topics/infertility/ perspective/en/ Ombelet W. (2011). Global access to infertility care in developing countries: a case of human rights, equity and social justice. Facts, views & vision in ObGyn, 3(4), 257–266. Available online at https:// www.ncbi.nlm.nih.gov/pmc/articles/ PMC3987469/ American Society for Reproductive Medicine, 2012. Age and Fertility. Available online at https://www.reproductivefacts. org/news-and-publications/patientfact-sheets-and-booklets/documents/ fact-sheets-and-info-booklets/age-andfertility/ Harper, J (2019). Launch of a global fertility education poster campaign.

Available online at http://www. globalwomenconnected.com/2019/10/ fertility_ed/

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101 HEALTH RESEARCH + PSPHP = HEALTH SECURITY SCIENCE GROUP

Our Health Security Science Group is a unique partnership between the Philippine Society of Public Health Physicians and 101 Health Research that provides technical assistance to companies in developing their capacity to prevent and control COVID-19 in the workplace. To achieve this, our team of experts conducts a comprehensive risk assessment, performs descriptive epidemiology and outbreak investigation, and determines whether a company is in crisis.

To perform a comprehensive risk assessment, we do a series of workplace visits and conduct a COVID-19 specific workplace risk assessment to identify specific areas or practices that may be controlled to decrease the likelihood of COVID-19 transmission.

We provide specific actionable recommendations, and do a post-intervention evaluation. Many of our recommendations are based on the principle of hierarchy of controls, as well as current evidence-based recommendations from global guidelines.

Integral to the situational assessment is describing the current epidemiology of COVID-19 in the workplace. This includes determining the burden of disease in the company: how many cases there are, how rapid is the rate of increase of cases, including absenteeism and presenteeism, and what the common characteristics of the cases are. We therefore also do outbreak investigation to determine whether any cluster can be identified and whether local transmission is likely. From here, we assist the companies in setting up case detection, who and when to test, and how to deploy contact tracing in the workplace. It is crucial that a company is able to routinely capture complete and real-time data, so we assist the companies in setting up interventions such as daily health declaration, and network graph analytics from QR codes to track their movements within the buildings.

We also use principles from disaster risk reduction for crisis management and business continuity planning. We build capacity within companies to set up their own Incident Command Centers, to organize themselves in dealing with COVID-19 outbreaks within the company (and prepare them for future disasters). This includes planning for business continuity while dealing with necessary controls or changes brought about by the pandemic or by government regulations. This also includes fostering trust and communication, and ensuring wellbeing and resilience of the employees.

At HSSG, we believe that private sector enterprises play a central role in public health and in rebuilding the nationâ&#x20AC;&#x2122;s economy.

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Collaborative Open Science during Pandemics Dominic Vincent Ligot If on March 25, you had told me that in three short months the country would experience a lockdown longer than Wuhan China, be used to Zoom conferences, and we would be nursing no less than 33,000 cases of COVID I would have been naturally skeptical. At the time, COVID-19 case counts had just breached 500 and was on its way to 1,000.

A few weeks earlier WHO had just declared COVID-19 (then called nCov-2019) a global pandemic, and local scientists had started to release forecasts of the looming epidemic.

On March 25, we called a meetup inviting Dr. Erika Legara, Dr. Darwin Bandoy and Dr. Jomar Rabajante, three scientists who had published forecasts in the media, to discuss their methods. That humble meetup proved to be a success and was one of the first of many ensuing online discussions on the ongoing pandemic (readers can access the fateful meetup on https://ethics.ph). After the meetup, Dr. Miguel Salazar of Philippine Society of Public Health Physicians,

invited us to join a Viber group to convene a group of doctors, scientists, and public health professionals looking to integrate data science, epidemiology, and clinical expertise for COVID-19. This would be the inception of what would eventually become L4H. L4H is short for Leading Evidence-based Actions through Data Science for Health Security and Resilience. The consortium spans eight organizations led by PSPHP and includes De La Salle University, University of the Philippines, UPLB BioMathematics Initiative, Ateneo School of Medicine and Public Health, MetaHealth, the Analytics Association of the Philippines, and CirroLytix Research Services.

The consortiumâ&#x20AC;&#x2122;s work focuses on analytics that is not simply a recycling of facts and figures already presented

by DOH and other trackers but looks at complimentary and decision-based analytics.

Epidemic Indicator Dashboard showing data on transmissibility and deadlines of the current pandemic

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CO-INFORM Rish Dashboard showing metrics on hazard, vulnerability and resiliency.

Headlining the work is the Epidemic Indicator dashboard which features the Time Varying Reproductive Number (Rt) and Case Fatality Rate (CFRt) which tracks the transmissibility of the virus and the deadliness of the current pandemic. In addition to epidemic indicators, the work also features the groundbreaking and innovative CO-INFORM Risk Dashboard which attempts to analyze the country in terms of hazard, vulnerability, and resilience metrics.

The insights also extend past the current pandemic as a guide to improving the country’s resilience against future pandemics and disasters.

The group is currently working on more localized indicators and ways to deal with the systemic data quality challenges of the public health sector as well as developing informative content to guide the public against fake news and disinformation related to COVID-19.

Dominic is the founder and CTO of CirroLytix Research Services, a social impact data analytics company focusing on public health. He also cofounded the Analytics Association of the Philippines. In 2019, Dominic led the Philippine team that won the Best Use of Data Award at the NASA International Space Apps Challenge for predicting dengue outbreaks using satellite remote sensing, climate data, and social listening.

Today L4H continues to thrive, under the watchful guidance of Dr. Jason Alacapa and Dr. Lester Geroy, PSPHP regulars Dr. Miguel Salazar and Dr. Jelo Apostol, and the continued perseverance of data modelers Dr. Peter Cayton, Jan Gil Sarmiento, Robert Neil Leong, Tessa Tan, Dr. Mike Promentilla, April Anne Tigue, Dr. Jomar Rabajante and Dr. Darwin Bandoy.

L4H is proof that a collaborative and data-driven initiative can thrive if founded on trust, open science, adaptive research, and with a pure non-political aim by concerned individuals and experts to help the country. As the current pandemic continues to rage, I sincerely hope this is a harbinger of brighter times ahead.

The LEADS for Health Security and Resilience (L4H), in strong partnership with its convening institution PSPHP, was instrumental in securing a subgrant from USAID ReachHealth, implemented by RTI International. This L4H supported PSPHP project is officially called the “LGU Leading Evidencebased Actions through Data Science (LEADS) against COVID19” inspired by the consortium’s name. The technical assistance aims to build seven Local Government Units’ capabilities to effectively and appropriately analyze and utilize COVID-19 data ,and prepare evidence-based plans to respond to COVID outbreaks, including forecast of pandemic and response scenarios.

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Establishing a Framework to Welcome Public Health Associates into the PSPHP family Lester Sam A. Geroy, MD, MPH, MSc-HPPF Among the many privileges we have as public health physicians while working in Rural Health Units is working with nurses, medical technologists, pharmacists, physical therapists, nutritionists and midwives. In most cases, being the only physician in rural areas with a population of thirty to fifty thousand people, we understand the importance of working with colleagues who actually do much of public health work with us.

As we move forward into the profession, we leave RHUs and join provincial and regional health offices. All the more we meet other colleagues who equally perform essential public health work with us. We meet IT specialists, engineers, epidemiologists, architects, lawyers, communication experts and more.

At some point in our careers, we decided to hone our knowledge and skills by further studies locally or abroad.

And there we find classmates, friends and professors from even diverse backgrounds such as business and management, economics, finance, philosophy, political science and many more. We appreciate even more that enhancing public health and the health system requires coordinated work and expertise from different fields. In terms of functions and roles, us physicians eventually decide to focus on tasks that take us away from the role of managing patients on a day to day basis. We become managers, researchers, communicators, policy makers, system designers, mentors and advocates. In many of these roles, we work even closer with colleagues who assist us in research, management, analysis, writing, communication, policy work, community mobilization and organizing events that influence how public health is delivered.

In the core values of PSPHP, bayanihan requires that we work together with everybody in order to meet our goals and attain positive health outcomes for populations. We observe respect for colleagues, partners, stakeholders, officials and patients whatever their beliefs, cultures, race

This article is sponsored by the International Healthcare management Initiative (IHMI) in support of enriching public health in the Philippines and in other countries. Core movers of IHMI include Mr. Teddy S Dizon, Dr. Anton Javier, Mr. Michael de Leon, and Dr. Lester Sam Araneta Geroy among others.

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and values are. Humility requires an understanding that we are not experts of everything, rather we can learn from each other and from colleagues. Likewise, PSPHP core competencies include inter-sectorality, collaboration, openness, contextual awareness and systems thinking among others which are relevant as the society continues to explore opportunities for other professionals.

In 2018, a group of students from the University of the Philippines Open University formed a group to promote excellence and advancement in management and health systems knowledge and skills among Filipino healthcare professionals working in the Philippines and abroad. The International Healthcare Management Initiative aims to unite Filipino healthcare professionals and create a network of excellent managers, supervisors and researchers. Many public health professionals in their capacity have pursued advanced studies and are greatly influencing public health policy and implementation in the country. Many of them are in key agencies such as the Department of Health, PhilHealth, DOH Regional Hospitals and the Philippine Council of Health Research and Development (PCHRD), as well as academe, NGOs and research firms that provide evidence, piloting and implementation of public health innovations.

This group appeals to PSPHP to accept public health and health system practitioners and experts among non-medical doctors. Through this strategy, PSPHP can maximize its influence on the strengthening of public health and health systems that would benefit populations not only in the Philippines but in other parts where Filipino colleagues are actively serving.

In the spirit of excellence, which is one of the core values of PSPHP, recognizing public health professionals who will specialize in public health shall require that they shall pursue further studies â&#x20AC;&#x201C; Masters and PhD â&#x20AC;&#x201C; in public health and related fields. This quest for excellence shall enrich the field and contribute to the improvement of societies and peoples that we serve.

The Ruth Foundation Spearheads the Development of Palliative Care Guidance Rumalie Alparaque-Corvera, MD, FPSHPM and Lester Sam A. Geroy, MD, MPH, MSc-HPPF Among patients that need continuous care during the pandemic are other conditions that require attention and care especially those with chronic illnesses e.g. kidney diseases, cancers, bedridden patients, persons with disabilities and those with terminal conditions and facing the end of life.

The Ruth Foundation, in partnership with Hospice Philippines, the Philippine Society of Hospice and Palliative Medicine and the Philippine Society of Public Health Physicians, developed three-part guidance documents that may be used in communities and hospitals in provinces.

These are provisional recommendations that aim to enable health professionals and workers make decisions and provide continuing care for these conditions.

Part 1 or the Care for Palliative and Bedridden Patients in Communities during Community Quarantine introduces palliative care and compassionate communities. The topics are set on the pandemic scenario and discuss Common Health Concerns; Management in the Home; Care in the Communities; End of Life Care; and Bereavement Care.

Part 2 or Guidance for Palliative, Hospice and Bereavement Care for COVID-19 and other Patients facing Life-Threatening Illness in Hospitals includes topics on: Symptom Management; Optimizing Hospitals for Provision of Palliative Care in Pandemics based on international practices; Dying Process and Immediately After Death; Bereavement Support; and Legal, Social, Spiritual, Religious Aspects and Funeral Arrangements. It is targeted to health workers in Level 1 and 2 hospitals, especially those without a palliative care specialist.

Part 3 includes Triage Decisions, Shared Decision Making and Advanced Care Planning for COVID-19 Situation: A Guidance Document for Levels 2 & 3 Health Care Facilities. The guidance document provides General Principles and Responsibility of Healthcare Providers; Fundamental Ethical Principles; Healthcare Challenges in the COVID-19 Response Scenario; Triage Decisions; Shared Decision Making; Advanced Care Planning (ACP); and Goals of Care.

Photo of Webinar with Muntinlupa City Health Office, 25 August 2020

Short courses and webinars were conducted among health workers in April and May at the height of Enhanced Community Quarantine. In August 18, 25 and 27, a webinar series was also conducted for Muntinlupa City Health Office and City Hospital. These webinars are designed to increase awareness among health and social workers of palliative care needs in their communities, as well as allow discussions and strengthening of existing networks and referral systems that would link patients from communities to hospitals. The speakers were top palliative and hospice care experts and advocates from different parts of the country.

These short seminars while focusing on COVID can prepare health officials and workers for the upcoming national program on palliative care that will be implemented at all levels.

PSHPM, Hospice Philippines and The Ruth Foundation may be reached through the Palliative Collaborative hotline for inquiries and concerns: 09063141421 Globe (02) 8938-0069 PLDT mobile landline

Cover page of Part 1 of the three-part guidelines

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Philippine Society of Hospice and Palliative Medicine Written and compiled by Rowena Marie T. Samares, MD, FPSHPM Karin Estepa-Garcia, MD, FPSHPM Mari Joanne Guerzon-Joson, MD, FPSHPM Arabelle Coleen P. Ofina, MD, FPSHPM Djhoanna Aguirre-Pedro, MD, FPSHPM It was in the late 1980â&#x20AC;&#x2122;s when the concept of Hospice and Palliative Care was integrated in the Family Health Care Program of the Department of Family and Community Medicine (DFCM) of the University of the Philippines-Philippine General Hospital (UP-PGH).

The focus then was Home Care to serve patients with chronic debilitating illness and those with difficulty in traveling to the hospital.

In the following decade the recognition of Hospice and Palliative Care as a distinct medical field was further promoted in private and government hospitals. There emerged various community-based related services in different areas involving a variety of population groups such as the volunteers, groups which provide spiritual care, groups for children and other patients with emerging infectious diseases among others.

A fellowship training program for physicians was initiated in UP-PGH. Graduates of the three (3) - year Family and Community Medicine residency program were eligible to pursue this subspecialty field. The Philippine Society of Hospice and Palliative Medicine (PSHPM) was officially organized by the pioneer graduates of the training. These developments initiated the start of two additional institutions offering subspecialty training in Southern Philippines Medical Center in Davao City and Jose B. Lingad Memorial Regional Hospital in San Fernando, Pampanga.

The PSHPM in partnership with Hospice Philippines, Philippine Society of Public Health Physicians and The Ruth Foundation released three Guidance Documents for Palliative Care to address the needs of patients and families during this COVID19 pandemic.

Even during crises, these societies and organizations work hand-inhand for policy development that will ensure the rights of patients in terms of receiving palliative care. These guidance documents aim to provide recommendations for quality palliative care for patients facing serious illnesses. It will also enable families and

communities to participate in the palliative care of patients through the prevention and relief of suffering, as they attend to the physical, functional, psychological, practical and spiritual consequences of serious illness, in partnership with their primary health care provider especially in these trying times. These include (1) Care for Palliative and Bedridden Patients in Communities on Enhanced Community Quarantine; (2) Guidance for Palliative Hospice and Bereavement Care for Covid-19 and other patients facing Life-Threatening Illness in Hospitals; and (3) Triage Decisions, Shared Decision-Making and Advanced Care Planning for Covid-19 Situation: A Guidance Document for Levels 2 and 3 Health Care Facilities.

There is a need to deliver Palliative and Hospice Care Services but several limiting factors were recognized such lack of specialists/ providers, access and equitable utilization. The timely passing of two substantial laws namely, the National Integrated Cancer Control Act (NICCA) and the Universal Health Care Law forged ahead the need to integrate this essential service and respond to the limiting factors recognized. As a result, the Department of Health (Department Order 2020-1431) initiated the development of the Manual of Operations, Procedures and Standards and Training Modules with Phase One Implementation of the National Palliative and Hospice Care Program. This project mainly aims to create an enabling environment to provide palliative and hospice care services for all Filipinos.

The future for Hospice and Palliative Medicine is a long journey and more policies geared toward achieving the needs across all service levels are to be developed. More patients must benefit from this care and as the country steps up its health system to a more inclusive one, every person must now become aware of hospice and palliative medicine.

Palliative care must not be experienced inside the hospital only, it must be holistic and must involve the community as well, as it must be done at the comfortable place for a patient needing it. Dr. Djhoanna AguirrePedroâ&#x20AC;&#x2122;s involvement in the community palliative care started as being a volunteer at Ayala Alabang Hospice Care Foundation at Muntinlupa City. The type of patients this foundation caters to are the marginalized and financially challenged, but there are about 10% who are also living inside the executive village of Ayala Alabang. The pandemic changed the level of protection needed but it did not hinder the delivery of the service. The heart continues to burn with the passion to serve.

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On July 10, 2014, Davao Regional Medical Center established the first Palliative Care Service in Davao del Norte initially providing for in-patient and out-patient referrals. The program headed by Dr. Suzette A. Solis has since expanded to include its own Palliative Medicine Ward providing palliative care for patients in Davao del Norte extending to the communities of Davao de Oro, Davao Oriental and Caraga Region.

Dr. Arabelle Coleen Ofina has been with The Ruth Foundation as a palliative care doctor for almost 6 years. There is a sense of fulfillment when she sees symptom-free patients enjoying their lives with their loved ones at the comfort of their homes. In the community, providing palliative care is beyond being just a doctor but extends to being an educator, counselor, researcher, social mobilizer and a spiritual care provider. The COVID-19 pandemic is an extra challenge when simple comfort measures of holding the hands of patients became difficult. It was hard to talk to patients and the families with the respirator and the extra personal protective equipment. Compassion during this pandemic is shown in more creative ways.

Dr. Mari Joanne G. Joson of Makati Medical Center is an advocate of life satisfaction affected by a personsâ&#x20AC;&#x2122; illness. In palliative care, quality of life is about relationships. There is a need to be honest, to be a good listener and be gentle. The end of life deserves as much beauty, care and respect as the beginning and it places a high premium on dignity, compassion, humaneness and respect for the humanity of another.

Photo Credit PSHPM

The Philippine Society of Hospice and Palliative Medicine was established in 2015 and recognized as a subspecialty organization of the Philippine Academy of Family Physicians. The mission of the organization is to see that all patients with serious life-limiting illnesses and their families will have timely access to high-quality Hospice and Palliative Care as an integral part of the Healthcare System. PSHPM seeks to promote and advocate for easily accessible high quality palliative care, and its delivery to everyone, by fostering and sharing high quality hospice and palliative care education, research, policy, and evidence-based practice, towards a nation free from health related suffering.

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Walking Free: A Journey from Evaluation to Policy and Sustainability Josephine Robredo-Bundoc, MD, DPBRM, FPARM

Physicians for Peace believes that its vision of “Local Applicability, Global Acceptability” was attained when “Walking Free” was showcased during the UN High Level Meeting on Disability and Development to push international cooperation for the WHO Global Cooperation on Assistive Technology. “Walking Free” presented a template that developing and low-income countries can simulate towards accessible, appropriate and affordable prostheses.

Physicians for Peace Philippines (PFPP) was created in 1998 to provide access to assistive technologies, specialized surgical care, quality burn care and maternal and child care.

PFPP envisioned that the prostheses Filipinos will use will not only be locally applicable but also globally acceptable. To achieve this, appropriate, affordable, accessible prostheses must be provided. Thus, the program “Walking Free” was created in 2005 to promote functional return through all walks of life.

As a strategy, the program had three phases. Phase 1 (2005 to 2010) focused on Evaluation that included collaboration with partners, multi-stakeholder consultations and outreaches for screening and provision of services. Phase 2 (2007 to 2012) focused on Implementation that included resource mobilization, satellite training and service centers and the initiation of policy development. Phase 3 (2009 to 2014) shifted towards Sustainability through public-private partnerships and community participation and inclusion.

By 2012, Walking Free was able to address the challenges to prostheses access. Data was generated from mission & satellite centers census and Walking Free‘s ASCeNT (Amputee Screening through Cellular Networking) Mobile

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App, that provided the numbers to convince PhilHealth to create the 1st ever package for Persons with Disabilities, the Z MORPH Below Knee Prosthesis Benefit Package, thus, cost of good quality prostheses became affordable.

Along with Walking Free, PFP Philippines created other programs “Hearing Health Care”, “Burn Care Rehabilitation” and “Seeing Clearly”, specifically focusing on assessments, partnerships and providing access to services for hearing, burn and vision especially in remote areas.

By 2014, Walking Free attained its Phase 3 public-private partnerships objective with regional centers increasing from 3 to 6; LGUs (like Sarangani) provided PO workshops & prothetists as counterpart to an investor ‘s start-up equipment and supplies; health care facilities with no prosthesis service capability but with many amputees (like Zamboanga City Medical Center) signed an MOU with investors for PO workshops, manpower & utilities. All PPPs were mandated to comply with the PhilHealth Benefit Package contracting requirements to ensure not only affordable but also appropriate prostheses.

In 2015, PFPP with support from UNICEF worked closely

PFPP doing collaborative prosthesis screening and provision missions coupled with multistakeholder consultations that will identify the factors that hinder grassroots access to prostheses

with the Department of Health (DOH) and PhilHealth to develop the Benefit Package for Children with Disabilities.

The policy was approved in 2017 and 2018 and initial contracting of hospitals started in 2019. In 2019, PFPP continued the work with DOH, the Philippine Academy of Rehabilitation Medicine (PARM) and other Professional Societies to gather evidence and support the development of PhilHealth Benefits for Rehabilitation for Adults. This is still ongoing reviews and benefits design.

Engagement in policy work has allowed PFPP experts to understand the real situation of rehabilitation in the Philippines, including limitations in health services, medicines and supplies, availability of assistive technologies and the herculean task of producing a multi-disciplinary workforce at all levels of care. Policy engagement and dialogue has gone beyond DOH, the National Council for Disability Affairs (NCDA) and PhilHealth to work further with TESDA, Professional Societies and Regional Hospitals.

2nd Flr. SILAHIS ARTS & ARTIFACTS 744 Gen. Luna Street Intramuros Manila 1002 Phone: (+63 02) 2415009 • (+63 02) 7100715 • (+63 02) 7101577 Mobile: (+63) 920-9506986 • (+63) 9328499212 Fax: (+63 02) 2415009 Email: lyneabanilla@yahoo.com • physiciansforpeacephl@gmail.com www.physiciansforpeace.ph

Physicians for Peace’s Walking Free Program is in its 15th year of existence. Its intended lifespan was only 10 years and it is supposed to have ended last 2014. Yes, Walking Free outlived itself but not its cause for being. It has progressed to “Walking Free and Beyond” when it shifted gears from advocacy to Health Research and Development.

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LGU Leading Evidence-Based Actions through Data Science (LEADS) against COVID-19

Fast Facts Total Budget: Php 5,460,000 Duration: August to December 2020 Funded by: United States Agency for International Development (USAID) ReachHealth Project led by RTI International

Goal To strengthen the capacity of local government units to respond to the COVID-19 outbreaks effectively and appropriately using evidence-based measures.

Location Directly assists seven provinces and cities namely: Rizal and Cebu Provinces, Caloocan City, Zamboanga City, Davao City, Cotabato City and Cebu City.

Key Components 1.

Support in improving COVID-19 data build-up and management by ensuring accurate and timely data collection and reporting.

2. Enhance capacity to analyze and utilize data for decision-making, particularly for local health resource planning, scaling up service delivery provision, and forecasting of pandemic evolution scenarios.

3. Support in developing a local COVID-19 response, recovery, and contingency plan based on local data and other available 86 evidence.

BACKGROUND The Philippines is seen to be suffering from a continuous increase of cases, with a recorded total confirmed case of 265,888 as of September 14. With the nationwide easing of quarantine measures, the surge in cases continues to weigh heavily on local government resources and the country’s health system capacity.

In the early months of the outbreak, the Philippine Society of Public Health Physicians (PSPHP) convened a multidisciplinary team of public health experts, project managers, as well as data science professionals to assist and support the government in managing the public health crisis. This led to a partnership among expert groups: PSPHP, LEADS for Health Security and Resilience Consortium (L4H), Health Security Science Group (HSSG), and Alliance for Improving Health Outcomes-Zuellig Family Foundation (AIHO-ZFF) Team, who developed products and tools, such as the LGU toolkit, health security package, and COVID-19 dashboards and heat maps.

FORGING PARTNERSHIPS FOR COVID-19 RESPONSE The USAID’s ReachHealth project entered in a partnership with PSPHP to support the scaling up of technical assistance to LGUs in enhancing their response and recovery plans.

This project paved the way for PSPHP and other experts to work hand in hand and harmoniously adapt and utilize their collective knowledge and skills to support the LGUs from assessing their existing protocols and identifying gaps to capacity building and co-developing sustainable response and recovery plans.

The USAID’s ReachHealth supported project, LGU LEADS against COVID-19, commenced in August 2020 and is into its second month of implementation. PSPHP teams are already working with the target LGUs and other key partners on the ground and have conducted an initial scoping activity. Together, with the seven partner LGUs, PSPHP have identified good practices and challenges encountered in terms of human resources, technology transfer, coordination, capacity building, and data management and utilization. These findings are the basis for developing LGUspecific technical assistance plans to be implemented in the months ahead.

For more information on the project, kindly contact the PSPHP Secretariat through psphpofficial@gmail.com.

PSPHPâ&#x20AC;&#x2122;s LGU Toolkit to Combat COVID-19 A key component under the LGU LEADS against COVID-19 grant was for PSPHP to support local COVID-19 response.

One of the technical tools that will be provided to partner LGUs was developed by PSPHP through its expert group with Alliance for Improving Health Outcomes with Zuellig Family Foundation (AIHO-ZFF). The toolkit aims to help local governments assess and build their capacity to contain COVID-19 through community-based measures.

The toolkit contains four modules with different objectives and outcomes: Module 1 aims to assess and build the LGUâ&#x20AC;&#x2122;s preparedness and response strategies in dealing with COVID-19; Module 2 focuses on case finding and contact tracing; Module 3 guides LGUs in the establishment of isolation units; and finally Module 4 focuses on a familyoriented approach to prevent and manage COVID-19 cases.

The toolkit begins with an overview labeled as Module Zero.

This provides a summary of the toolkit as well as explains the rationale behind the community-based approach that the package aims to build to prepare the LGUs for the rest of the toolkit.

The first module focuses on assessing and building LGU preparedness and response mechanisms. Targeted towards provincial and municipal Inter Agency Task Force (IATF) representatives, Barangay Health Emergency Response Team (BHERT) representatives, and private sector and civil society, the module uses Operation LISTO classifications, used originally for disaster preparedness and response, to categorize response levels and the corresponding priorities and objectives for each level. Incident command systems are established and identified, and the roles each organization has is made clear to improve coordination between everyone involved in the pandemic response.

With organizational tasks having been assigned and risk assessment performed to determine response level in the first module, the second module focuses on finding and classifying cases. Through this module, the concepts behind disease transmission, contact tracing, and communication with the community are discussed. The use of Filipino values such as tiwala, pang-unawa, and malasakit

are utilized to help establish rapport between the BHERTs representatives - who are responsible for case finding and contact tracing - and the community so that members of the community understand the importance of the measures taken to prevent transmission as well as reduce the stigma caused by contracting the virus and cooperate with response mechanisms.

To aid the contact tracing efforts established by the second module, the third module helps LGUs with establishing isolation and treatment areas. The aim of the third module is to establish LIGTAs COVID (Local Isolation and General Treatment Areas for COVID-19 Cases) centers to provide an alternative to home-based isolation. This allows individuals who are suspected to have COVID or present mild symptoms to be isolated in specialized facilities when home-isolation is not possible. This module is currently being updated to reflect the recent DOH/IATF-endorsed strategy for managing COVID-19.

The last module of the toolkit focuses on managing COVID-19 at the individual level by emphasizing the different risk factors that could be present within the household and how LGUs can respond to these risks efficiently. Healthcare workers are taught how to interact with patients and families to improve their understanding of the situation while managing their concerns and preventing any unnecessary panic. A list of actions that families can take based on their risk classification are presented to minimize the spread of COVID-19 within the community.

With this toolkit, PSPHP hopes to build and enhance the response mechanisms within the LGUs. From establishing clear command structures and providing guidelines in handling patients, to communicating the right information and easing the worries of the community, the tool was designed recognizing the huge role LGUs play in controlling the spread of disease. While working with the DOH, DILG, other key government agencies and technical partners is important, engaging local communities remains to be the best bullet in our fight against COVID-19. And this is precisely what the toolkit is all about!

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NORFIL Foundation and PFP Philippines Conducts a Webinar Series on Overcoming the Limitations of Quarantine on the Care for Children with Cerebral Palsy during COVID Recovery With the current quarantine measures in place to mitigate the COVID-19 pandemic and ensure low to zero transmission, access to health care services has become limited, affecting the most vulnerable, especially children with disabilities.

In response to this, NORFIL Foundation Inc. and the Physicians for Peace Philippines organized the webinar series Overcoming the Limitations of Quarantine last July 28-30, 2020 to capacitate and empower parents, caregivers and community workers to continue quality and safe practices and services for children with cerebral palsy during the pandemic. The first series conducted was a three-day short course on the care and management of children with cerebral palsy at home, which focused on conducting mobility exercises, observing proper feeding techniques and maintaining and utilizing mobility devices.

Additionally, in celebration of the World Physical Therapy Day, a special webinar and online forum titled Service Innovation in the New Normal was conducted last 08 September 2020. Several organizations and service providers from across the country catering to children with disabilities participated and discussed their experiences in the provision of community rehabilitation services during the pandemic including the challenges they encountered, the types of services provided and practices observed.

For inquiries about upcoming webinars and courses, please contact NORFIL Foundation through norfilfoundation@yahoo.com

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Health for Our People: Designing Change 2nd Philippine Society of Public Health Physiciansâ&#x20AC;&#x2122; National Convention

16-18 September 2020 Zoom Webinars Co-presented by Panahon.TV

On 16-18 September 2020, the PSPHP has set another milestone in the public health landscape by conducting the 2nd Public Health Convention (PHCon) 2020 using a virtual platform. Various health professionals engaged in public health and related fields attended the webinar. PHCon 2020 sparked discussions on overlooked public health issues and concerns. The convention highlighted the significance of co-creation, and the knowledge and opportunities the various health care actors provide.

SESSION 1 Strategic Leadership in Health Crises Co-presented by Alliance for Improving Health Outcomes

Session 1 explored the insights on after-action review processes to evaluate real-world experiences exemplifying strategic leadership.

Convenor

Dr. Miguel Manuel Dorotan Executive Director, Alliance for Improving Health Outcomes

Presenters

Strategic leadership in crisis Dr. Manuel M. Dayrit Former Health Secretary Adjunct Professor and Former Dean, Ateneo School of Medicine and Public Health When were we at our best? A reflection of a politician Hon. Maria Isabelle G. Climaco Mayor, Zamboanga City

SESSION 2 Engaging the Communities as Partners during Health Crises Co-presented by University of the Philippines Manila Convenors

Session 2 discussed the strategies and engagement mechanisms to empower communities as partners for health, especially during health crises.

Dr. Paolo Victor N. Medina Assistant Professor, Department of Family and Community Medicine College of Medicine, University of the Philippines Manila Dr. Jaifred Christian F. Lopez Assistant Professor and Special Assistant to the Dean College of Public Health, University of the Philippines Manila

Presenters

Ownership, co-ownership, and co-creation towards health resilient communities Dr. Jean-Marie A. Egargo Public Health Manager, Center for Health Development - Eastern Visayas Community engagement and empowerment towards better health Dr. Editha C. Miguel Executive Director, Agape Rural Health Program Mechanisms to foster an enabling environment for community participation and empowerment Dr. Anthony Rosendo G. Faraon Deputy Executive Director, Zuellig Family Foundation

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SESSION 3 Partnership for Sustainable Innovations in Public Health

Session 3 aimed to generate ideas to sustain advancements on innovations in public health.

Co-presented by Social Innovation in Health Initiative Philippines Convenors

Dr. Noel R. Juban Project Lead, Social Innovation in Health Initiative Philippines Dr. Christian F. Gomez Founding Board Member, Philippine Society of Public Health Physicians

Presenters

â&#x20AC;&#x153;Walking Freeâ&#x20AC;? towards assistive technology and rehabilitation Dr. Josephine R. Bundoc Program Director, Physicians for Peace Philippines Government and academic partnerships to sustain advancements and scale-up innovations in public health Dr. Belen L. Dofitas University of the Philippines Manila

SESSION 4 Linkages and Building Resilient Health Systems Co-presented by College of Public Health, University of the Philippines Manila Convenors

Encouraging local industry innovators to invest and transfer technology for the benefit of public health Dr. Jaime C. Montoya Executive Director, Department of Science and Technology - Philippine Council for Health Research and Development

Session 4 highlighted how information could boost health care provider networks and promote health resilience.

Dr. Michael S. Caampued Founding Board Member, Philippine Society of Public Health Physicians Dr. Katherine Ann V. Reyes Assistant Professor and Associate Dean for Research College of Public Health, University of the Philippines Manila

Presenters

Setting up and operationalizing health facility amidst COVID-19 pandemic Dr. Paulyn Jean B. Rosell-Ubial Former Health Secretary Facility Manager, Quezon Institute

Financing resilient health systems Dr. Eduardo P. Banzon Principal Health Specialist, Asian Development Bank

How HTA can contribute to a resilient health system and strengthen collaborative partnership with the private sector Dr. Denese S. Cabigting-De Guzman Medical Officer, Department of Health Central Office

SESSION 5 Evidence-based Actions in Public Health through Data Science Co-presented by LEADS for Health and 101 Health Research Convenors

Session 5 showed innovative ways to utilize data and evidence through data science for public health.

Dr. Jason Alacapa Consultant, LEADS for Health Dr. Venus Oliva Cloma-Rosales Managing Director, 101 Health Research

Presenters

Using data science in health care and public health Dr. Aileen R. Espina Member, Philippine Society of Public Health Physicians Value of data science in public health Mr. Wilson L. Chua Big Data Consultant, Futuregen International Pte Ltd

Epidemiological parameters for COVID-19: concepts and analysis Dr. Jomar F. Rabajante Affiliate Faculty Member University of the Philippines Open University

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