A culture of risk and danger?

A culture of risk and danger?

Updated 10:21pm (Mla time) Sept 28, 2004
By Michael Tan
Inquirer News Service



Editor's Note: Published on page A14 of the September 29, 2004 issue of the Philippine Daily Inquirer


WHY do we constantly take risks? In Tagalog we use the word "ligtas" to mean safe, but think hard now, how often do you actually use the word? Think, too, if you can translate "Is it safe to cross the street here?" into Tagalog. Or, would you ask, "Is this medicine safe?"

These were the questions I had to grapple with in my head as I prepared a talk for the national convention of the Philippine Society of Hospital Pharmacists, who decided that for this year, their theme should be "Establishing a Culture of Safety in Health Care." I shared some points about the cultural aspects of safety during that convention, but I thought it might be useful to use my column today to look into why we seem so cavalier and careless about safety issues in general.

Ignorant bliss?
Generally, people don't usually go around constantly thinking of safety issues as we eat, drive, cross the street or take medicines. In a way, that's a good thing because if we were so obsessed with safety issues, we'd end up paralyzed by fear.

On the other hand, people in developed countries are generally more conscious than those in developing countries of safety issues as these relate to food, medicines, our homes and offices and the natural environment in general.

Environmentalist and consumer groups are supported by mass membership and lobby constantly for stricter safety standards for everything from cars to toys.

The differences in attitudes toward safety issues boil down to the way we perceive risks. Obviously, we'd have to start first with whether we recognize risk situations in the first place. For example, many people are unaware that the medicinal cabinet in the toilet is one of the worst places to keep medicines. A recent report from England warns that under very warm and humid conditions, certain medicines might expire even before the date stamped on the package. Now if that risk exists in England, you can imagine what it's like for a tropical country like the Philippines. Yet, unaware of research findings about the effects of heat and humidity on medicines, Filipinos, British, Americans and many other nationalities still believe a toilet is the best place for a "medicinal cabinet."

Moving away from medicines, we see all kinds of other examples of blissful unawareness that put people at risk. We see kerosene stored in softdrink bottles, for example, and kept in the kitchen next to food items. Not surprisingly, the Poison Control Center at the Philippine General Hospital keeps getting cases of kerosene poisoning. Pesticides, too, are often kept and used carelessly. I've seen in rural areas pesticides kept next to infant formula!

Relative risks
Mass media and schools play important roles in bridging the information gap to help people become more safety conscious. On the other hand, not all of our risk-taking is caused by lack of information. We may be aware of the risks of doing something and yet continue to disregard warnings about those risks. I could name a thousand examples here, from not using pedestrian lanes to smoking.

One interesting explanation for this behavior is that people generally enjoy taking risks, with some people actually deriving a high from the most risky activities. Despite this enjoyment of risk, we do compare risks with benefits. Sometimes, the perceived "benefits" come from a no-choice situation. We know the pedestrian lanes are useless in places like the Quezon Memorial Circle and Commonwealth Avenue, given the Metro Manila Commission's flea-brained traffic scheme that has converted several of Manila's thoroughfares into racetracks. Sure, there are also pedestrian overpasses but these are built every two kilometers or so. Confronted with the risk of being run over and the hassle of having to walk several meters, for a Filipino, the "rational" choice is clear.

The relativity of risks gives rise to all kinds of forms of risk calculation. When we take medicines, we don't ask, "Is this medicine safe?" Instead, in English, Tagalog, Cebuano and whatever local languages we speak, we ask: "Is this medicine OK?"--with "OK" mainly referring to the expected benefits, relief from a headache, for example.

Another interesting example comes from the many interviews I've had with women who tell me natural family planning is not safe. Medically speaking, NFP is actually the safest, but the women explain it is "not safe" because it puts them at greater risk of pregnancy than, say, the pill.

Let's face it, given that the life of the average Filipino is already so fraught with risks, there's a greater tendency to trivialize even the most serious risks. When the government banned Filipinos from working in Iraq, there were vehement protests from those who wanted to go. I remember one applicant appearing on TV, quite agitated and angry, complaining that it is more unsafe to stay in the Philippines than in Iraq because here, their families were always in danger of starving.

Clearly, our notions of risks are based on the here and now. Many Filipinos, in fact, describe risk as "panganib" or danger, which isn't quite the same. Dangers are immediate, visible. For the Filipinos who want to go to Iraq, even the dangers in that country, so clear in the news, is still too distant, too invisible.

Modernity and risks
If underdevelopment and poverty seem to make risk-takers of us all, there's another interesting theory of risk, from Ulrich Beck: that modernity (and development) actually puts entire societies into risk situations. Here, it is a blind faith in "progress" and in technological advances that make us so uncritical in accepting technologies, from medicines to nuclear plants.

Ironically, it is now in the most developed countries where faith in science is being challenged. As societies modernize, they move on to an "interrogative mentality," a situation of "reflexive modernization" where you have more skeptical and critical individuals. A patient, for example, is no longer, well, a "patient" patient, passively accepting all that the doctors say. In developing countries, we rush to take the latest drugs on the market; in developed countries, people will be more cautious and ask their doctor, "It's so new. Are you sure it's safe?"

With the explosion of information sources, people can and should be taught to ask the right questions about risks and safety. Safety then becomes truly a matter of ligtas, which is not just "safe" but "saved from" particular risks.

Please disturb

Please disturb

Updated 11:01pm (Mla time) Sept 23, 2004
By Michael Tan
Inquirer News Service



Editor's Note: Published on page A15 of the September 24, 2004 issue of the Philippine Daily Inquirer


EVERY evening at the Rockwell Center in Makati City, as plush boutiques wind down their activities, there is a building that goes in the other direction, coming alive as hundreds of students stream into Ateneo de Manila University's Professional Schools for their classes in law, government, and business.

For two nights this week, the building was busier than usual as the school brought several hundred students together for plenary lectures, part of an extraordinary exercise called Mulat-Diwa -- an opening of the mind or, in the words of Dr. Alfredo Bengzon, who heads the business school, "the eyes of the heart" -- to get the students to reflect on how business might contribute to the task of nation-building.

I was invited to lecture on culture and nation building while Ateneo's own Father Jojo Magadia spoke on economics, politics and poverty. I will admit that even after years of teaching, I found the assignment daunting. After all, we were being asked to deal with some 800 people at each session, our lectures transmitted live to several sites within the Rockwell campus, as well as to Ateneo's extension sites in Santa Rosa, Laguna, Subic, and Cebu City.

Skeptical? I will admit I was that way too; after all, talk about social conscience and nation building isn't usually done in a business school. Yet, by the end of the second round of talks, I could feel the atmosphere in the auditorium, and in the remote sites, was charged. People were, well, disturbed, and that was the most important point of the exercise.

Body mining

Before the plenary lectures, the students got to see an episode of GMA Network's TV program "Imbestigador," titled "Pobreng Pinoy" [Poor Filipino]. I have worked with the poor in rural and urban areas for many years, but "Pobreng Pinoy" still had new shocking revelations.

What was most striking about the documentary was the way the poor find ways to survive: subsisting on instant noodles, setting up shacks on rivers (to get around the ban on squatting on land), taking over abandoned vehicles to build a home. But its most disturbing revelations were about the selling of body parts, "kinakalkal ang katawan," or "mining the body," as program host Mike Enriquez put it. We hear of such cases, but I was not quite prepared to learn the extent of what could be sold.

"Pobreng Pinoy" featured professional blood donors, something the public has been aware of for a long time. But that was the mildest example of body mining. It also featured a man who had sold all his teeth to dental students needing subjects to practice tooth extractions. He still goes to these dental students, this time to let them practice on his mouth for the fitting of dentures. He has also become an agent, looking for other people willing to let dental students practice their extraction skills on them.

Another man interviewed on the show talked about how he had donated some of his skin for a patient needing grafts. He got P5,000 for a small piece of skin from his leg, and now plans to sell his kidney. The trade in kidneys is actually thriving, with buyers sometimes coming in from overseas.

The most shocking example of body mining was a man who had sold one of his eyes, for P50,000, the money used up to treat his mother's heart condition.

There were other heartbreaking stories in this trade of body parts, ending with a mother who had accepted P50,000 from someone who wanted to adopt her newborn child.

A nation dismembered

During one of the plenary sessions, the topic of overseas Filipino workers came up.

While recognizing the extent of remittances coming in, Father Jojo wondered if overseas labor was really making a dent on people's lives. Sure, homes are built and children get to finish college because of the remittances, but Father Jojo also wondered how much of workers' earnings go into productive activities to make a difference for national development.

I had to speak out, too, again acknowledging that our overseas workers are making heroic contributions to the Philippine economy but wondering what the long-term costs would be. I shared the story of a 21-year-old girl who had been recruited to work in Japan. She had become pregnant before she could leave, and after the baby was born she began to consider the possibilities of paying her way out of her contract.

The people at the promotions agency did not take kindly to her request to withdraw from the recruitment, first telling her she'd need to pay at least P70,000 for expenses they'd incurred for her training and documentation. Not only that, the staff lectured her on the need to be more responsible: "Aren't you ashamed to your younger brother and sister? By not going to Japan, you're letting them down."

As if that statement was not bad enough, she was always hectored: "Someday when your baby grows up, don't you think you'd be ashamed telling your child that you chose not to go to Japan to work?"

My regular readers know I've always been supportive of overseas workers but there are times, and they are becoming more frequent, when I wonder what the long-term social costs will be for such large-scale deployment.

The anecdote about the young girl who had just delivered stirred up the audience, and got Dr. Alfredo Bengzon to speak out, too, and to compare this massive exporting of labor to the trade in body parts. As our Filipinos leave, we become a nation dismembered, much like the poor who sell vital body organs.

My main concern is the way overseas work has totally changed, well, distorted, our priorities. Our national development plans seem to hinge on this export. Business establishments aim for the returning overseas worker, and their families, for their market -- everyone else seems too poor to afford to buy anything. Many of our schools have become mass assembly lines for a global labor market. And, most sadly, families now tell their kids, "You have to at least finish high school so that someday you can work abroad."

Finding the stars

Our plenary talks at the Ateneo had started out with a prayer written by South Africa's Archbishop Desmond Tutu. It was appropriately entitled "Disturb us, Lord," calling on God to stir the spirit "when we are too pleased with ourselves, when our dreams have become true because we dreamed too little; when we have arrived in safety because we sailed too close to the shore... when because of the abundance of things we possess, we have lost our thirst for the water of life; when, having fallen in love with time, we have ceased to dream of eternity." The prayer dares us to be bold, to venture out to the seas during a storm so that, "losing sight of land, we shall find the stars."

During the open forum, someone asked, "How will we find those stars?"

Maybe poverty, because it is so overwhelming lulls us into collective denial of our problems. If we are to chart our own national destiny it is time we put up signs that read, "Please do disturb."

Cultural liberty

Cultural liberty

Updated 06:07am (Mla time) Sept 22, 2004
By Michael Tan
Inquirer News Service



Editor's Note: Published on page A15 of the September 22, 2004 issue of the Philippine Daily Inquirer


DOES culture affect development?

Over the last hundred years or so, social scientists have debated this link. Max Weber, for example, wrote, almost a hundred years ago, that there was an "elective affinity" between Protestantism and the development of capitalism. In the period after World War II, many social scientists were recruited by development agencies to look into cultural reasons behind underdevelopment. In the Philippines, certain values, such as “hiya” [sense of shame] and “utang na loob” [debt of gratitude], or even the entire "flawed culture" have been blamed for our underdevelopment.

Now the UN Development Programme (UNDP) has come out with still another exploration of the links between culture and development. Their latest Human Development Report is different though in that it rejects the idea that culture dooms certain countries to failure.

Multiculturalism

While in the past social scientists were busy trying to describe cultures in a homogenous way -- for example, most Filipinos carrying the value of “bahala na” [come what may], or most Filipinos using their nose to point -- the UNDP emphasizes that even within a culture, there is much diversity and variation. Even more importantly, it is this diversity, and the freedom to practice and develop that diversity, that are crucial for development.

What is the link here? I'm going to give some of my own ideas as an anthropologist who has worked in development for several years. Cultural liberty and diversity mean tapping into a greater reservoir of talents and skills. This even includes worldviews, how we look at a problem. For example, we often end up being on the receiving end of development plans from the United States, formulated by bureaucrats in Washington. Yet the solutions to some of the most difficult problems in many of our communities may come from indigenous knowledge, from the "natives" who know their own environment.

The extent of "cultural liberty" depends on a country's multicultural policies, described by the UNDP as those "that recognize differences, champion diversity and promote cultural freedoms, so that all people can choose to speak their language, practice their religion, and participate in shaping their culture -- so that all people can choose to be who they are."

The UNDP emphasizes that it is important to develop these multicultural policies because in two-thirds of the world's countries, there are minority groups that make up more than 10 percent of the population. Just watch the "American Idol" competitions and you can already see how "American" has become so diverse, including any number of ethnicities, including Filipinos.

The Philippines, too, is extremely diverse, culturally. I walked through one densely populated street in Manila’s Sampaloc district the other night and heard the dialects Ilokano, Cebuano, Waray, Ilonggo, Kapampangan, Maranao... and Hokkien Chinese being spoken. There were, I am sure, other Filipino languages I couldn't quite identify.

Language isn't the only marker for ethnic diversity. There are differences in clothing, food, architecture, even body language (I've always felt Visayan groups are more alive with their body movements).

Another aspect of cultural diversity is religious affiliation. We say Roman Catholicism is the majority religion in the country, but there are in fact variations to being Roman Catholic. You have, for example, Mike Velarde's El Shaddai, which many people think is a separate sect but is actually still, for now at least, part of the Catholic Church. Certainly, El Shaddai has its own culture, its own variations on the practice of Roman Catholicism, some of which are looked upon with some discomfort by the bishops-the famous upturned umbrellas, for example, to receive heaven's blessings.

'Isang bansa, isang diwa?'

The leaders of many young nations, the Philippines included, have tended to subscribe to the idea that the way to development comes by uniting the country, and by trying to create a common culture.

This approach is best epitomized by a slogan used during Ferdinand Marcos' time: "Isang bansa, isang diwa" [one nation, one spirit]. The slogan is difficult to translate but more or less refers to the idea of having one country and one spirit. How is this diwa, or spirit, to be brought about? We see this even in textbooks, with all the references to national symbols, the national flag, a national bird, a national flower... the list goes on and on.

The problem with this approach is that a choice of one symbol may displace many other possibilities. Thus, when the Tagalog dialect was chosen as the basis for Filipino, it provoked negative reactions from Cebuanos, who rightly pointed out that there were actually more native speakers of Cebuano than Tagalog.

More than holidays

The first chapter of the Human Development Report talks about the need to be able to practice one's own religion, to speak one's language, to celebrate one's ethnic heritage, "without fear of ridicule or punishment or diminished opportunity."

It's a point we should reflect on. Just think of the stereotyped biases Tagalogs have against the "Bisaya," the noun becoming a pejorative adjective. The Bisaya will often fight back but with smaller ethnic groups, a child may grow up ashamed of his or her culture and suppress it. That is a loss for the entire country because that takes away from the national pool of knowledge we could otherwise have.

Even worse, the suppression of particular cultures further reinforces biases against the discriminated groups because we fear the unknown. And as biases grow, resentments may spill over into violent civil strife, as we see with our Muslims.

Promoting cultural liberty takes many forms. For example, the President has included the start and end of Ramadan as national holidays, recognizing Muslims are now everywhere in the Philippines and would appreciate those holidays.

But declaring Ramadan a holiday should also be an opportunity to educate non-Muslims about Islam. I worry that Ramadan, and Islam, will remain exotic and distant unless the mass media help to explain to people what the spirit of the fasting is all about, and how people of other faiths might want to relate to that special season for Muslims. I'd also like to see recognition of Ramadan incorporated into work policies, to make employers more understanding of the needs of fasting Muslims. The nongovernmental organizations (NGO) I work with are conscious, too, about avoiding Ramadan when scheduling a training workshop or seminar. (This year, Ramadan more or less runs from Oct. 15 to Nov. 14.)

There's much more, of course, to the practice of cultural liberty, but we should start with our homes, pointing out to our children the beauty of cultural diversity in our own environment and making sure they don't tease other children because they're of a different race, ethnicity or religion.