Senior citizens and their medicines

Senior citizens and their medicines

Updated 01:23am (Mla time) Nov 26, 2004
By Michael Tan
Inquirer News Service



Editor's Note: Published on page A15 of the November 26, 2004 issue of the Philippine Daily Inquirer


THERE are more than three million Filipinos aged 65 and above, many suffering from chronic diseases (hypertension, diabetes, arthritis and rheumatism) for which they need to take daily medication.

At the family reunions I attend, I constantly hear the elderly complaining about how they spend several thousand pesos a month for their medicines. For the poor, it is even worse, with even the lower-priced drugs posing a heavy burden.

Take the case of a senior citizen receiving P1,800 a month from her social security check, translating into a daily budget of P60. If she's put on one of the cheaper beta-blockers to control her hypertension (high blood pressure), she will still need P30 a day just to get that medicine. That's half of her daily budget.

No win

Some relief has been available through a mandatory 20-percent discount on senior citizen's medicines but that benefit may now disappear. The Drugstore Association of the Philippines (DSAP) and several senior citizens' organizations are now in a gridlock over the discounts after Health Secretary Manuel Dayrit issued an administrative order reducing the discount from 20 percent to 3 percent on prescribed branded medicines. The earlier 20-percent discount would have remained for generic medicines.

Dayrit was responding to complaints from drugstore owners that they had on average only a 15-percent profit margin on their products and that they were losing money with the 20-percent discounts given to senior citizens.

There was an outcry from the senior citizens' groups protesting Dayrit's order. The DSAP proposed a compromise, extending the 3-percent discounts to supplements or natural medicinal products, which were not previously eligible for senior citizens' discounts. The senior citizens were not to be placated, insisting on a 20-percent discount for all drugs.

We now have a no-win situation but it isn't just the drugstore owners and senior citizens who lose. What we see here is another chapter in the never-ending saga of a nation held captive by the drug industry, with government unable to offer anything except stopgap measures such as the senior citizens' discounts.

I've been working on pharmaceutical issues for many years, but the full impact of this desperate situation hit me only last Wednesday as I listened to lawyer Susan Pearl Villanueva as she explained legal issues around drug prices during an Akbayan national conference on health issues.

Lack of competition

Villanueva is a top-rate lawyer, a bar topnotcher and a specialist on intellectual property rights, which she handles as a private lawyer. Her analysis of our quagmire boils down to this: Drug companies can get away with their high prices because there is a lack of competition, a situation brought about by our government's, I will be polite here, timidity.

Much has been said about how drug companies dictate their prices because of their abuse of the patent system. The drug companies can dictate prices partly because of a patent system that allows them exclusive rights to produce and distribute a medicine. This used to be 17 years but has been extended to 20 years, courtesy of the World Trade Organization (WTO) expanded system.

But Villanueva emphasizes that the WTO itself agreed at a meeting in Doha on a number of "flexibilities" allowing governments to get around the patent requirements for public health reasons. For example, governments can invoke compulsory licensing, requiring a drug company to license other firms to produce their drugs at lower cost. Villanueva pointed out that we have a law that allows compulsory licensing but this is rarely used because it takes so long for our Bureau of Patents to approve an application, with the drug companies further delaying the process by challenging these requests.

Many drugs remain expensive even after they go off patent because we remain dependent on a few large multinationals for our medicines. One measure is parallel importation, which our Department of Trade and Industry (DTI) has attempted. Here, the DTI imports the same branded preparations as those sold by multinationals in the Philippines, but from other subsidiaries of the multinationals that charge lower prices, usually the ones in India. I can see why, for example, the anti-hypertension medicine Inderal (propranolol) costs P11 here but the same branded preparation costs only about P3 in Delhi.

Corporate terrorism

The multinationals responded by suing the DTI, including officials in their personal capacity, claiming exclusive rights to sell the medicines locally. Again, the sad fact is that there are international agreements that could be enacted into local laws to protect our DTI officials from corporate terrorism but this has not been done.

Villanueva discussed other alternatives to reduce drug prices. The government could provide more support to local companies producing low-cost but quality generics. Or it could go into centralized procurement of essential medicines, and provide these to the public. The government is in a position to negotiate for better prices if it would pool all its drug requirements together, whether for the Department of Health’s hospitals or its other agencies (for example, the Department of Education and the Department of National Defense).

Finally, our government needs to strengthen its anti-trust laws to prevent monopolies. Unfortunately, our government does not intervene, claiming we respect free enterprise.

Our health care system apes that of the United States, which over-emphasizes protection of businesses. It is not surprising that health care is now so expensive in the United States, and that includes medicines, with few safety nets to help the poor or senior citizens.

American senior citizens are at least an organized lot, with powerful lobbying groups. They've also looked for other sources of medicines, including buying them from Canada, where government intervention has brought down the costs of the drugs.

Our senior citizens have much less power, so the government needs to do more to protect their interests. We need to look into the issues mentioned by Villanueva, including her advice for government to have a unified plan and to speak with one voice. For example, you can't have the trade department doing parallel imports while the courts are used by multinationals to bully conscientious government officials with lawsuits. Similarly, you can't ask drugstores to give a 20-percent discount on drugs while allowing the drug companies to charge such high drug prices to the retailers, with only a 15-percent margin of profit.

100,000 children

100,000 children

Updated 03:53am (Mla time) Nov 24, 2004
By Michael Tan
Inquirer News Service



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


THINK of a fairly large nursery or day-care center with about 100 toddlers -- children below five years old -- in their care. Imagine a thousand of these day-care centers to visualize, however roughly, 100,000 of these toddlers.

You reach out for an imaginary dial to turn down the volume because the 100,000 toddlers can create quite a din. Turn down the volume on the squealing, giggling, laughing, babbling, until you get complete silence. Deathly silence.

Of the 2.5 million babies that will be born in the Philippines this year, 100,000 will not live to the age of five.

This figure is projected out of statistics from the 2003 National Demographic and Health Survey (NDHS), released two weeks ago. The NDHS asked 13,000 women a battery of questions, including several on the number of children they've had, and infant and child deaths. Based on this information, they were able to calculate infant mortality rate, which is the death rate of children below the age of one year, and the under-five child mortality rate.

The statistics are grim: For every 1,000 births, 29 will die during infancy, and 11 more will die before the age of five. The total under-five mortality rate is therefore 40 per 1,000 (or 4 percent of total births), which is how we derive the figure of 100,000 deaths.

Stalkers

What are these children dying of? I looked up the last Health Statistics yearbook of the Department of Health and wrote down the top 10 causes of death for infants, and then toddlers. The pattern reminds me of what I was looking at 20 years ago, when I first began to do public health research. Among infants, many of the deaths occur shortly after birth, caused by "birth injury and difficult labor" as well as congenital anomalies. Throughout infancy, the babies continue to ward off the Grim Reaper's many stalkers: respiratory diseases, diarrheas, measles, and malnutrition.

Among children aged one to five, the pattern is all too similar to that of infant deaths, with the addition of chronic obstructive pulmonary diseases (asthma, bronchitis, and emphysema), and accidents.

Some of these are not easy to deal with -- for example, the pollution that contributes to chronic respiratory ailments. But many of the other deaths can be prevented through provision of more and better quality health services, as well as improving access to these services. Note that access here isn't just a matter of physical facilities. For example, the government now provides free vaccines for children, including hepatitis B, yet the NDHS found that 30 percent of households had children with incomplete immunizations and seven percent had no vaccines at all.

Clearly, there's a failure here of health information and health education for parents. We grieved reading about the children who died from food poisoning because the father had fed them scraps obtained from garbage. I suspect there have been many similar cases that didn't make it to the press-those who died not just because of unsanitary preparation of food but due to severe under-nutrition caused by parents' poor understanding of nutritional needs, or chronic malnutrition which can kill a child slowly through starvation by making the child more vulnerable to all kinds of diseases.

Social barometer

Back in the 1970s, I listened to a lecture by Dr. David Morley, a renowned British pediatrician and public health worker, where he pointed out that child death rates are sensitive social barometers, its level, as well as its rate of decrease, telling us volumes about a country's priorities in development.

The NDHS, which is conducted every five years, has been chronicling the trends in these death rates. In the 1993 NDHS, the under-five mortality rate was reported at 54 per 1,000 births or 5.4 percent. This dropped to 48 in 1998 and to 40 in 2003. Progress has been made, but the rate of decrease has been slow, and the current figure of 40 is still high compared to those of many other countries.

The under-five mortality rates seem to parallel economic development. Among our neighbors, the most impressive rates are found in Singapore, with four per 1,000 live births and Malaysia with eight, figures that are even better than that of the United States. Thailand, which is more developed than we are, has a rate of 28. Indonesia, which is a bit poorer than we are, has a rate of 45.

But it isn't just economic development that brings down child death rates. The term "political will" has become such an over-used cliché but yes, government investments in health care do save children's lives in a dramatic way. Cuba, a country that is poorer than we are but with completely subsidized health care, has an under-five death rate of 9, about the same as that of the United States. Singapore and Malaysia's impressively low rates are products too of strong public health system supported by the state. Vietnam, which is poorer than the Philippines but has a socialized health care system, has a rate about the same as ours: 38 per 1,000 live births.

Our lackluster performance in bringing down child death rates also reflects serious economic and social inequities. It isn't surprising that the National Capital Region had an under-five death rate of 31 per 1,000 live births while the Autonomous Region in Muslim Mindanao had 72. Likewise, with the poorest 20 percent of households, the under-five death rate is 66, while among the richest 20 percent it is 21.

The NDHS figures also show how family planning can bring down the death rates. In households with only one child, the under-five death rate is 36. If there are four to six children, the death rate goes up to 45 and if there are seven or more, the rate is 83.

The most dramatic differences correlate with the education of mothers. In households where women had some college education, the under-five death rate was 18. In households where women had no formal education at all, the rate was an astounding 105. That last figure means that one out of every 10 babies born to these mothers will die before the age of five. There is a vicious cycle created in such households: Couples, aware of the high rates of child deaths in their family, will actually keep having more children to make sure they have enough surviving children.

The NDHS figures tell us it takes so little to save children's lives: more money and human resources for delivering basic services in communities and schools. Our unwillingness to invest in our children's health means many wasted lives, not just of the children who die but also of survivors who will continue to suffer from health problems later in life. They are the ones who queue up in government hospitals, or troop to radio and television stations, hoping for a dole-out. They, too, will bring the next generation of children into the world, as unprepared as their parents were. The lives of this next generation of Filipinos will again be all too short, flickering candles placed out in a storm.

Endangered families

Endangered families

Updated 03:20am (Mla time) Nov 19, 2004
By Michael Tan
Inquirer News Service



Editor's Note: Published on page A15 of the November 19, 2004 issue of the Philippine Daily Inquirer


"LISTEN to mother," Winnie Monsod declared to the audience. An economist and former director of the National Economic and Development Authority (NEDA), feisty Winnie was reacting to the findings of the 2003 National Demographic and Health Survey (NDHS) released just last week by the National Statistics Office and the US-based ORC Macro.

Her point is that while we're always preaching about the need to listen to the advice of our mothers, we don't seem to be as willing to listen to them when they talk about their problems and needs. The NDHS gives us an important opportunity to listen to the mothers, since it involved interviews with 13,945 women nationwide, a large percentage of whom were mothers.

The 2003 NDHS is actually the eighth of a series of surveys that started in 1968. It was originally called the National Demographic Survey and focused only on family planning. Over the years, the surveys have been expanded to include all kinds of health issues. The latest report, summarized -- note, summarized -- in a 377-page volume and covering a wide range of topics, from breastfeeding incidence to awareness of tuberculosis.

Because so many facts and figures go into the NDHS reports, they can be overwhelming and when picked up by the press, their impact tends to be reduced, people ending up bewildered by all the percentages.

Red flags

I will be using other NDHS findings in future columns but for today, I wanted to put up some red flags, picking out the more striking figures and supplementing them with statistics from other surveys to highlight the great risks faced by Filipino families, especially mothers and children.

• Some 2.5 million babies will be born this year -- that's four babies born every minute.

• The number of pregnancies here was probably higher, many lost through miscarriages and abortions. Some of these losses were due to poor maternal health, aggravated by the pregnancies being unplanned or unwanted. The NDHS reveals that only 55 percent of the pregnancies were wanted or planned.

• Of the 2.5 million babies born this year, 1,350,000 are in high-risk categories for illness or death because of fertility-rated factors, meaning their mothers' age (too young or too old), short birth intervals or too many siblings born before them.

• Of the 2.5 million babies that will be born this year, 10,000 will die before the age of 5.

• The high child death rates should not be surprising considering that in the NDHS, 30 percent of children aged 12 to 23 months had not received full immunization against six preventable diseases. Seven percent of the children (that would be about 175,000 if the trend continues) received no vaccinations at all.

Unequal risks

The NDHS reminds us that health risks aren't shared equally. The inequality is most obvious with gender. Only two-thirds of the women interviewed said that they had "consensus" with their husbands on the number of children to have. In other words, behind the unplanned pregnancies aren't just lack of access to contraceptives but also a man who wants to have more children than his wife does.

The NDHS breaks some of their figures down by age, residence (rural/urban, region), educational attainment and, for the first time, wealth or income. The figures are consistent in showing more serious problems in rural areas, in regions such as the Autonomous Region in Muslim Mindanao (ARMM) and with the poor.

To give one example, in Metro Manila, 70 percent of births were in health facilities while in the ARMM, the figure was only 11 percent.

We could look, too, at the total fertility rate (TFR) or the number of children a woman has in her lifetime. On average, a Filipina wants to have 2.5 children but ends up having 3.5. The gap between the wanted and actual TFR grows as you go down the income ladder. Women in the richest 20 percent of households in the NDHS wanted an average of 1.7 children but ended up having 2. In contrast, women in the poorest 20 percent of households wanted an average of 3.8 children but ended up having 5.9.

Even the risks for early marriage, which generally means more children and problems with child-rearing, will vary by income group. The median age for first marriage among women from the richest 20 percent of households was 24.6 years. For the poorest 20 percent it was 19.7 years.

Who is to blame?

It's tempting to blame this dismal state of affairs on a particular president, or Cabinet member, but the period between the NDHS surveys is a gray area. The current report is about data collected in 2001, while the previous report's data were collected in 1996. Between 1996 and 2001 we had three presidents: Fidel Ramos, Joseph Estrada and Gloria Macapagal-Arroyo. This was also the period when the "Asian flu" (the regional economic crisis) broke out.

But we have to remember that despite the Asian flu, neighboring countries were able to keep their social services running, meaning education, health, nutrition, population and social welfare. In contrast, our already weak social services were further emasculated: education and health budgets being the first to be cut each time the government called for austerity. As if all that were not enough, corruption further eroded the already paltry budgets.

When I realized the NDHS data were collected shortly after Arroyo became President, I became even more uneasy. What happens as we go through more years of a national leadership marked by a continuing refusal to recognize the problems of runaway population growth, by a shunting aside of family planning supposedly to uphold family values?

Certainly, family planning alone will not solve the problems enumerated in the NDHS but it can help us buy time as we try to solve the problems. During the opening ceremonies for the NDHS launch, Carina Stover of USAID called on the audience to "listen to the numbers" and shared some figures to remind us we are racing against time. The 2.5 million babies born this year will mean P3.4 billion more each year just for the vaccines (sourced at the lowest prices) to protect them from life-threatening diseases. Those babies also mean we will need some P2 billion to build 52,000 more classrooms for them, when they get to be of school age.

Do we need more shortages in vaccines, textbooks, health care centers and classrooms, as well as the 2008 NDHS figures, to convince us that the Filipino family is indeed endangered?

Emotions for sale

Emotions for sale

Updated 01:20am (Mla time) Nov 17, 2004
By Michael Tan
Inquirer News Service



Editor's Note: Published on page A15 of the November 17, 2004 issue of the Philippine Daily Inquirer


THE STORY is now well known. A 12-year-old Filipina named Faye allegedly won honors for the Philippines in two international scholastic competitions but had received no recognition or support from Filipinos, even after she and her mother were robbed in Australia. The article contrasted Faye's situation with the celebrity status bestowed on Jasmine Trias, the Filipino-American runner-up in an "American Idol" competition.

I first got the story last Oct. 31 through an e-mail, entitled "Misplaced Priorities Can Mislead a Nation," but decided not to feature it because I had serious doubts about its authenticity. My reservations arose partly from my instincts as a mass media person, and partly as an anthropologist with a special interest in what we call urban folklore, concocted stories or rumors that gain wide currency until it is accepted as the truth. I was particularly suspicious about the international competitions: while such events would probably have received less attention than "American Idol," they would still have caught the mass media's attention. Moreover, the long chain of mishaps, one following the other, that Faye and her mother met just seemed too fantastic, a typical characteristic of the many urban myths circulating.

Now the whole affair has been exposed as a hoax, leaving a very embarrassed Bread of Life Ministries (BOLM) which had been largely instrumental in publicizing the case. But I have great respect for BOLM and join them in their appeal to the public to be more forgiving and understanding, especially now that we know the mother was going through an emotional upheaval. Moreover, I did want to react to comments to the effect that this could happen only in the Philippines and that we are a nation of con artists and gullible victims.

Tearjerkers

Such scams, if I may use a strong term, are common throughout the world, an inevitable product of our times. As early as the 1950s, Western social scientists have been writing about how, in our modern times, emotions have been commodified, turned into "objects" that can be bought and sold. In this 21st century, with cell phones and the Internet, the market for these commodified emotions will expand even more rapidly.

This phenomenon is closely tied to the development of capitalism with its need to sell its mass-produced products. To do this, they realized effective advertising needed to appeal to people's emotions. Later, business people realized the potential not just in using emotions to sell products but to market emotions as well.

Emotions are a different sort of commodity. They're commodified partly because business people know that people enjoy a good laugh, or a good cry. Print and broadcast media thrive on the selling of these emotions as they are built into news and feature articles (yes, including opinion columns), sitcoms and the many soap operas, as well as in movies.

All these shows' ratings thrive on the human need for vicarious pleasures, meaning we share in the emotions depicted in media. We watch the latest episode in a soap opera and cry our hearts out. We join long lines to catch the latest horror film, whether it is "Feng Shui" or "Nightmare on Elm Street Part VI." And, wonder of wonders, we actually feel better after a good cry, or a good scream.

Reality shows are only the latest developments in this need for vicarious emotional pleasures, the intensity of the emotions heightened by our knowing that we're not just watching actors. We hold our breath watching "Fear Factor" as someone is lowered into a glass box with icy-cold water and given a minute to escape. We retch like contestants do when they try to eat as many cockroaches as possible in three minutes. And again, we feel good from feeling awful!

Reality or fantasy?

When we go through a particularly trying period in our lives, when nothing seems to go right after a partner's betrayal, a job demotion or a floundering business, a problem child -- all happening at the same time -- we joke about how we should write about it and turn it into a “telenovela” [TV soap].

It seems Faye and her mother were also grappling with one tragedy after another and, in response, spun this tearjerker for public consumption. Whether for money or for attention or for both, the point is that they knew their story would sell. It was reality TV gone awry.

For an emotion to sell, or to sell something, it needs to be anchored on reality. The story of Faye and her mother appealed because it tapped into the public's own frustrations with a government that is indeed lacking in priorities, with a society that does give singers and actors greater recognition than bright kids and scientists. There are so many other themes in the story reflecting our convoluted angst, for example, how Faye supposedly beat Germany and the United States. Wow, a Filipino beating these giants -- it makes a good feeling at a time when so many Filipinos slave away in those countries as service workers.

Faye's story warns us about the pitfalls of playing with people's emotions. Cause-oriented organizations, charity groups and religious groups have to be particularly careful because they, too, tap into this commodification as well with their press releases, solicitation letters and even homilies and sermons.

Perhaps the story of Faye can be transformed into a modern day parable. There are lessons to be learned here, of why we wanted so badly to believe the story, amid growing cynicism, despair and misplaced priorities. At the same time, the story should be there to remind us to be more vigilant about how emotions can be too easily exploited, sacrificing truth and reason.

Remembering 1904

This last section has nothing to do with the Faye story. I want to promote an event organized by the University of the Philippines (UP) in Baguio City to commemorate the centennial of the St. Louis Exposition. That exposition included a Philippine Reservation where 1,100 "primitive savages" were imported from the Philippines for exhibition, all to justify the US colonial experiment in the Philippines.

UP Baguio's "Revisiting the Fair: A 21st Century Look at the 1904 St. Louis Fair" will be held on Nov. 18 and 19 at the campus' Bulwagang Juan Luna, with lectures from several historians and social scientists, including Raymundo Rovillos, Oscar Campomanes, Stephen Totanes, June Prill-Brett, Patricia Afable, Deirdre McKay, Padmapani Perez and Antonio Buangan, a descendant of one of those who were exhibited in the States and never returned home.

Three films will be shown: "Savage Acts: Wars, Fairs and Empire," "A World on Display" and "Bontoc Eulogy."

For more information call Marlon or Bryan at the Cordillera Studies Center 442-5794 or e-mail cac@upb.edu.ph.

The de-skilling of our young

The de-skilling of our young

Updated 01:58am (Mla time) Nov 12, 2004
By Michael Tan
Inquirer News Service



Editor's Note: Published on page A15 of the November 12, 2004 issue of the Philippine Daily Inquirer


A STRANGER sight you couldn't imagine. One of my aunts woke up one morning to find her helper out in the garden, watering the plants. Nothing extraordinary there, except that the helper was struggling, trying to handle the water hose with one hand while using the other to keep an umbrella over her head.

My aunt asked why she had an umbrella and got this reply: "Because, ma'am, it's raining."

Stories of domestic helpers' gaffes are a dime a dozen, but this one of watering the garden in the rain, with an umbrella, was especially striking. My aunt lamented: "The day she arrived, she made it a point to tell me she had done a year of college and was well qualified. But, Mike, I'm finding that we're getting more of these younger helpers who have finished high school or done a bit of college but are a far cry from the older ones who may have only finished Grade 2."

College but de-skilled

It's a point well made about a growing problem we have among young people in general, whether they enter the labor force as domestic helpers, factory workers or office clerks. Educational attainment may be increasing, thanks in part to free public secondary education, but we have to be asking ourselves if the high school or even college diploma really means someone is prepared to meet life's challenges.

My view is that we're witnessing a massive, and dangerous, de-skilling of young people. When it comes to practical skills, rural youth have turned their backs on the farms, and on traditional work, including household basics, seeing all this as menial work. Urban youth may be plugged into the information revolution, but their skills are limited to texting and managing computer games. And generally, we see a generation that's reading less, thinking less.

The de-skilling of our young is probably worse with males because they are so privileged at home-by their mothers, sisters, girlfriends and wives. The other day one Ateneo professor told me this is particularly bad in one Central Luzon province (guess which one), where the women actually crack pakwan or watermelon seeds for their men. I'm being frivolous, of course, when I say that one of the skills being lost among men is pakwan-cracking. There are far more important skills they're losing, so it's not surprising to find, especially in urban households, idle, jobless men who can't find work and who are not very useful either at home.

Just to be more concrete, I'll share with you the story of a male college student who was working for someone part-time as an all-around Man Friday. One day, his employer told him they were going to start to compost kitchen waste. The employer brought out some flower pots and soil, explaining that the kitchen waste goes into the pots and then gets covered with soil. After a week, the curious employer went to check the pots and found they were filled with kitchen waste...still in plastic bags. Even more shocking was that out in the garden, there were several more plastic bags under the trees, the student proudly explaining he had done this to hasten the compost production, with the compost going directly to the trees.

Common sense?

Mind you, this was a UP student who had grown up in a rural area, but had no idea of how plants grow, how organic matter decomposes. And yes, I guess there was no common sense as well.

Common sense isn't instinctive. It has to be acquired. And we're not doing enough to cultivate this in homes or in school. Partly I think it's because our priorities have become so distorted, our main objective being to get our young into diploma mills so they can be exported to handle mechanical work.

Parents urge their kids to finish high school so they can work abroad and earn dollars. The kids in turn see all the returning overseas workers, including the japayuki, toting the latest models of cell phones and electronics and Marlboro and Johnny Walker. I'm therefore not surprised when young girls in middle-class and urban-poor areas in Quezon City, where I'm doing research, tell me: "Why go to college when you can go to Japan with a high school diploma?"

Indeed. Young urban girls do pick up skills, to survive in the streets, to be wily and charming. And the men? It could be worse.

In my research, I found one young male whose wife was working in Japan while he was jobless, living off her remittances. He had two of the latest cell phones-and a mistress.

The young men boast and compare notes about who's the "smarter" one with their women.

'Señorito, señorita'

Let's get back to Inday who was watering the plants in the rain. Her employer had another observation: "I have to say that with this new crop of helpers, they at least know how to dress, and to answer the phone. Why, they could pass off as a colegiala (a student at a private girls' school)."

What we're seeing here is the señorita complex. In the Philippines, "señora" is used as a term of courtesy and deference to a rich woman, and "señorita" refers to their daughters. Being "señorita" means dressing up, strutting around like a model on the catwalk, even learning to modulate one's voice. Which is all fine, except that being a señorita also means a disdain for work, especially work seen as menial.

In Thailand, in Indonesia and in Vietnam, I find more women driving motorcycles, carrying around heavy boxes -- work that our señoritas would consider degrading, "unfeminine" and well, "un-señorita."

I've written in the past about our men tending to be señoritos, but I'm now convinced we are afflicted as well with an equivalent for women, and unfortunately, you see this even in the poorest of households, which means both daughters and sons hanging around at home, refusing to take up certain jobs, or doing poorly at them because they think it's beneath their status.

It's time we exerted more effort, in homes and schools, to reverse this trend and explain that one's status isn't tied so much to the cell phone model you have as with honest labor, no matter how "menial," no matter how routine.

Sharing the loot

Sharing the loot

Updated 00:44am (Mla time) Nov 10, 2004
By Michael Tan
Inquirer News Service



Editor's Note: Published on page A15 of the November 10, 2004 issue of the Philippine Daily Inquirer.


"HEY, Mike," my Indonesian friend Muhadjir asked me the other day over a hearty dinner to end the day's fasting, "who did better this year in the corruption ratings: the Philippines or Indonesia?"

Muhadjir was referring to the latest Transparency International ratings of perceptions of corruption. I couldn't remember our rating, but I joked, "Oh, I think we're catching up with Indonesia..." (I checked later and found that the Philippines ranks 102nd while Indonesia ranks 133rd -- meaning we're still perceived as being less corrupt.)

Muhadjir continued with his interrogation: "Is it true what I heard, that even your lowest-ranking government personnel have also learned to be corrupt?"

I was startled by his question because I'd always presumed corruption was found through the rank and file of government offices, but then I did remember reading, a few weeks ago, about a customs utilities person who was being investigated because he had several vehicles. Maybe Muhadjir had heard right about even our lowest-ranking government workers learning to get their share of the bribes.

I did remember, too, many years ago when we were under Marcos and the Indonesians were under Suharto, how we'd compare corruption. Many observers familiar with both countries agreed that corruption in both countries, during the dictatorships, was mainly concentrated among top officials -- with one difference: Our biggest thieves were a greedy lot, reluctant to share their loot, while in Indonesia, the big fish tended to share their earnings with their subalterns.

Decentralized, democratized

What's happened after the dictators fell? These days, Muhadjir laughed out loud, because governments have been decentralized to local units (like in the Philippines), the corruption has been decentralized as well.

An interesting point, I thought. Can corruption be decentralized and democratized, to promote, albeit perversely, greater equity?

Unexpectedly, I got my answer when one of my relatives' former household helpers came visiting last week to seek my help. Inday had worked for many years with my relative, who had, on my prodding, been paying premium for her to the Social Security System (SSS) during her last few years of work. Inday had since retired and gone back to her hometown in the Visayas, looking forward to a simple but comfortable life, with help from her SSS retirement payments.

Unfortunately, Inday never got around to getting an SSS card, which the local office was asking for. So she was now in Manila to try to get that card. I asked why she had to come all the way to Manila, presuming that queues would be shorter and the staff would be friendlier in the offices outside Manila?

Inday corrected me with a litany of complaints. The queues are longer because people come in from all over the region, from the most far-flung municipalities, and it's often chaotic, she explained, with missing and lost records and people generally not knowing what to do.

Worse, she said, corruption is endemic, from the lowest-ranking clerks upwards. She'd experienced that lethal look from clerks, a bored smile that said it all: "It will take time, maybe a few weeks, maybe a few months, to process your papers ... unless you want it facilitated."

She had been approached by fixers offering to help her with the retirement payments, if she agreed to pay a certain amount (it varied, from several hundreds to a thousand pesos) and if she agreed to give them a percentage of each retirement check.

I was horrified thinking of the scenarios. Maybe the SSS people were really honest and the fixers were outsiders and con artists who would run off with the facilitation fee. But the fact that they could roam the SSS office freely said something. And if perceptions were widespread about the need to go through these facilitators, then we probably have an even worse situation, of vicious thieves with connections within the SSS, able to tamper with the payments so the "brokers" could get their monthly cut.

Victimizing the victims

I guessed then. Now I can answer Muhadjir that yes, corruption has seeped down to the rank and file, and in the most vicious ways because people already beaten to the ground by poverty find themselves again victimized by corruption.

I'm not surprised that the poor complain constantly about all the documents they have to get from government agencies, from birth certificates to clearances from the National Bureau of Investigation, to health and retirement benefits. The procedures, and forms to fill out, can be daunting, and it almost seems they were intentionally made that way to breed niches for fixers and corrupt clerks.

It's infuriating because the poor do end up paying more, relative to their income, squeezed for every centavo they can give. And the poor are only to willing to pay the bribes because they do benefit in the end, even if to get paltry benefits like SSS retirement checks, which are then further reduced by the fixers' share. The wiser ones, like Inday, pay to come up to Manila to avoid the fixers, figuring the investment for the trip is better than giving up 10 percent of their monthly retirement checks.

Think of the variations here. A friend of mine had to go and claim his driver's license from the Metropolitan Manila Development Authority for a traffic violation. He got the smiles and the hints of delays, but he persisted and paid the prescribed P500. All around him, he could see and hear the wheeling and dealing, mainly involving jeepney and taxi drivers, who would pay under the table because they could not afford to wait. A day without a driver's license meant lost income. They paid P1,000 instead of P500, but still figured they came out winning because they could get back to work. Others paid because they didn't want the offense encoded into the computers and into their records.

It doesn't occur to these drivers that they actually lost P500 because of the bribe. Or, that other people lose, too, since the system encourages bad drivers to repeat their offenses because they know they can get away with it, again and again.

As corruption becomes the norm, the way to get things done, we can expect the poor to be victimized even more, the stakes increasing as more low-rank crooks and fixers compete. I've heard of many stories of intrigues among the clerks, of a pirating of clients, or of double-crosses when it comes to dividing up the loot. All this is bound to worsen as government cuts back on personnel even as the population grows, together with all the bureaucratic requirements.

These petty thieves are never going to get millions in kickbacks, but a few dozen victims a day can mean a more than comfortable life, maybe so much so that they won't even need to queue up for their retirement checks, when their time comes.

Talk about it

Talk about it

Updated 06:32am (Mla time) Nov 06, 2004
By Michael Tan
Inquirer News Service



Editor's Note: Published on page A15 of the November 5, 2004 issue of the Philippine Daily Inquirer


FOR many Filipino parents, sex isn't something you talk about at home, especially with their children. The reasons for this neglect vary, ranging from not knowing what to say to the idea that talking about sex will lead to having sex.

Other parents are willing to concede to some form of sex education, as long as this is done at home. The type of education here varies, from token discussions about the birds and the bees to fathers taking their sons to nightclubs and brothels and initiating them into "manhood."

Views on sex education in schools also vary. Some parents are only too happy to leave this task to the schools, while the more conservative are vehemently opposed to this, fearful that liberal teachers might instill strange ideas in their kids' minds, for example, that women should be independent, or that responsible parenting includes family planning, or, horror or horrors, that homosexuals have rights, too.

Where does all this leave our young people? Just last week, a secretary working for a non-government organization told me about a problem she was having with her eldest son, or rather with her son's school. Her story should remind us how complicated this matter of sex education is.

The notebook

I'm going to call this secretary Lina and her son, Jun. The son is 13, and has just started high school. The other week, one of his teachers called in the mother and showed her one of Jun's notebooks and, in disgust, pointed to two pages where there were "obscene" (“malaswa”) drawings, showing trysting couples.

Lina could sense this was a serious matter and tried to negotiate as respectfully as she could. She agreed that a school notebook isn't the place for such drawings, but also argued that the pictures only reflected the curiosity young people have about sex.

The teacher asked if Lina had been showing "dirty books" to Jun. Lina said that because of her work with NGOs, she was convinced it was important to talk with children about sex, and she had been passing on to Jun materials on sex appropriate for his age.

The teacher disagreed. "Kids these days already know too much," she complained, adding that recently, she had caught one of the students showing a condom to his classmates. "Imagine, a condom!" the shocked teacher said. "I've been married for so long and have never seen a condom, so I didn't even know what it was and why the students were giggling."

Lina knew she would be waging a losing battle with this teacher and asked what action was to be taken. The teacher was firm: The matter had been referred to the principal, and the boy would be suspended for two days.

FHM

Lina knew she had to choose her battles, and for this one, it would have to continue at home with her son. Jun was in tears when he got home, having been told of the suspension and thinking he was going to get an earful from his mother and maybe even a beating from his father.

But Lina was consoling and supportive, repeating what she had always told her children: Sex is good, without sex you would not have come into this world. But people have different ways of looking at sex and some people think it's dirty and disgusting. So, while we can be open at home about it, we should know too when to be quiet, when to be discreet. By "we" Lina meant herself and her children. Her husband isn't quite as open about sex.

So, she explained to Jun, that in a school notebook, at least in the school where Jun was studying, "bold" drawings would not be appropriate.

Lina asked me what it was like in the University of the Philippines (UP). I said that teachers at the UP high school probably wouldn't go around checking students' notebooks, in the first place, but if they did find "bold" pictures, they probably wouldn't suspend the student.

Lina was curious, too, asking Jun where he picked up the ideas for the drawings. He answered: "FHM." (For my more innocent readers, that's a widely sold magazine with photographs of minimally clad women.)

A wise Lina told me: "Sir, you see, you can be careful in choosing the sex education materials for your child but outside the home they'll still get other stuff like FHM."

We talked about how to handle FHM, explaining it's not the nudity per se that's the problem but the way women are depicted, reduced to objects for men to gawk at. But banning FHM, we both agreed, was not going to be the solution.

Moral compass

Lina knows there will be other "incidents," that you can't just pretend that kids will learn about sex on their own. It's a losing battle at times because, as Lina saw it, we are all bombarded with sexual images.

Screaming "bastos" every time a child talks about sex, or suspending a child for "obscene" drawings reflect immaturity on the part of parents and teachers, creating more problems. These moves tell the child that sex is wrong, that sex is dirty, and, worst of all, that they can't talk with a parent or teacher about such matters. If we continue to deny the need to talk about "it," the kids will only have their peers to rely on, peers who are as uninformed or misinformed as they are, and the motley assortment of books, magazines, movies and videos circulating around.

Some Department of Education officials I've talked with agree that there's a need for sex education in schools-not just boring anatomical charts explaining how babies are made but also "life skills," how young people can deal with courtship and dating. I've actually been apprehensive in this regard, feeling that if teachers themselves carry so many hang-ups and biases about sex, they could create still another generation of confused Filipinos.

There is, too, the paradox that amid the explosion of "sex talk" in mass media, parents remain at a loss as to how to open discussions about sex at home. Even my most liberal friends admit feeling awkward about initiating a discussion. Yet, all of them admit, too, that like sex itself, it's the first time that's the most difficult. Most say that when they first asked their children if they wanted to talk, the kids themselves laughed and began to "lecture" their parents about what they knew-which can be a lot, especially around acts and techniques.

It's the part of values that's often more murky, and that's where parents can play an important role. Parents can, by example and by discussion, equip their children with a moral compass, which they can use to decide for themselves. Start with where they are, encouraging them to share what they already know, so you can come in with your views, without becoming too preachy or judgmental.

Try it. You'll find it's not as difficult as you thought it would be and that it might even be fun, a chance to see and marvel at how your child is growing up. Avoid that responsibility, and you may find yourselves forced to talk about it after a serious problem (a pregnancy, for example) has already occurred.

Hobbit cousins

Hobbit cousins

Updated 11:19pm (Mla time) Nov 02, 2004
By Michael Tan
Inquirer News Service



Editor's Note: Published on Page A15 of the November 3, 2004 issue of the Philippine Daily Inquirer


"NEW species revealed: tiny cousins of humans."

"Little lady of Flores forces rethink of human evolution."

These intriguing headlines tell us about one of the most extraordinary fossil finds in half a century. The fossils, found in September last year in a rock shelter on the island of Flores in Indonesia, were reported in last week's issue of the British science journal Nature by a team of scientists from the Indonesian Centre for Archaeology and the University of New England in Australia. The fossils have been named Homo floresiensis, which means they are considered to be very close relatives to Homo sapiens (that's us).

The most exciting discovery was that of a nearly complete skeleton of a female, estimated to date back about 18,000 years. Eventually, more fossils have been found, the remains of at least seven other individuals, dating back between 13,000 and 95,000 years.

Tiny cousins

The female skeleton tells us Homo floresiensis stood only about a meter high, with a brain about one-third the size of modern humans. This is why Homo floresiensis has been described as our hobbit cousins (a New York Times editorial called them "Homo Tom Thumbus").

The new findings remind us how complicated human evolution can be. When I first took a physical anthropology course way back in 1979, the human family tree was relatively simple and straightforward: various Austrolopithecus species, each one having a brain larger than their predecessors, finally branching off into Homo. We had Homo habilis, the tool user, followed by Homo erectus (hey, easy now, erectus refers to our standing on two legs). Then finally, we came along and in our arrogance named ourselves Homo sapiens, the wise, the thinking Homo.

These days, I have to update every few weeks my lectures and student handouts for physical anthropology, adding new fossil findings (for Homo alone there are now nine different species discovered) and new theories around these findings.

How do the Flores hobbits fit into our family tree? The speculation is that they descended from the Homo erectus line. Much to the dismay of racists, all humans actually trace their ancestors back to Africa. Some 1.8 million years ago, Homo erectus began their long journey -- spanning many generations -- out of Africa.

One group eventually reached China, represented by the fossil remains of Peking Man. Another group reached Indonesia about 1.6 million years ago, and we have many fossil representatives here such as Java Man, Solo Man and Trinil Man. ("Man" here is generic; some of the fossils could have been female.)

The latest fossil findings tell us that Homo erectus continued to evolve. On the island of Flores, where food resources were scarce, the relatively large size of Homo erectus (they were about the same height as Homo sapiens) became a disadvantage. Natural selection favored a smaller body build as found in Homo floresiensis. They were small and their brains actually a size smaller than that of chimpanzees, but the fossil sites also yielded evidence that our hobbit cousins used fire, and fashioned stone tools. They were apparently able to hunt down the Stegodon or pygmy elephants, as well as giant lizards up to three meters long.

Based on the assortment and size of hunted prey, anthropologists speculate that Homo floresiensis had probably discovered the advantages of group cooperation for hunting, and may have developed language.

Philippine hobbits?

Why did they become extinct? One theory is that volcanic eruptions about 12,000 years ago may have wiped them out, together with the pygmy elephants.

But it's intriguing too that local folklore on Flores island includes stories about the "ebu gogo" (translated as the grandmother who eats anything) described as being short, long-haired, long-armed and pot-bellied that lived in caves and climbed trees. The ebu gogo were said to have disappeared after the Dutch arrived in the 16th century. Were the ebu gogo actually Homo floresiensis?

What does all this mean for the Philippines?

The oldest human remains we have are of Tabon Man, a skullcap found in Palawan Island and estimated to be about 16,000 years old. Tabon Man was Homo sapiens, meaning if you put flesh to the bones, Tabon Man would look like you and our brothers and sisters and mom and dad.

So far, Philippine excavations haven't yielded Homo fossils other than Homo sapiens but the fact that nearby Indonesia yielded so many fossil remains of Homo erectus and now, Homo floresiensis, makes me wonder if perhaps there are similar fossils waiting to be discovered. The province of Cagayan has yielded remains of the Stegodon. Were they hunted down by local bands of Homo floresiensis?

Talking fossils

I tell my students the fossils are alive, speaking to us, asking us questions. Our well-known cousin, Homo neanderthalis, hung around between 200,000 and 30,000 years ago, meaning they co-existed with a more recent newcomer, Homo sapiens. They had bigger brains than Homo sapiens, yet they disappeared. Was it a problem adapting to the natural environment? Or, shudder, did Homo sapiens wipe them out?

Homo floresiensis allows us to let our imaginations run even wilder. Maybe it's a collective memory of these hobbit cousins that account for folk tales, found throughout the world, about small human-like creatures, from leprechauns and hobbits to our “duende” [dwarfs] and “capre” [monstrous giants].

Did Homo floresiensis have any social contacts with Homo sapiens? Could they have inter-bred? Could some of us be carrying genes from our hobbit cousins?

Perhaps we are indeed a wise and thinking species, constantly wondering about the human condition and our existence. We've had satellite dishes listening to the universe, hoping to detect evidence of extraterrestrial intelligence. That search speaks of our loneliness, a fear that we might be alone in the universe. Sadly, that search has not yielded any evidence of extra-terrestrial intelligence.

The fossil findings here on earth have been kinder, telling us there have been others, almost human, maybe even human, who preceded us, who co-existed with us. The fossils remind us to be humble enough to recognize how new we are on earth and how precarious our existence is.

Perhaps millions of years from now, some new human species might stumble upon our fossil remains. I would hope they'd marvel at what we accomplished even with our primitive technologies. I would hope, too, that they will not sadly shake their heads as they realize that it wasn't volcanic eruptions, or giant asteroids smashing into earth, that wiped us out. Let it not be said that we were the first species wise enough to make ourselves extinct.