Math, physics and HIV/AIDS

Math, physics and HIV/AIDS


Posted 00:51am (Mla time) Feb 25, 2005
By Michael L. Tan
Inquirer News Service



Editor's Note: Published on page A15 of the February 25, 2005 issue of the Philippine Daily Inquirer


I WAS recently interviewing a 22-year-old male in an urban poor community for a sexuality research project, when he got around to boasting that he'd never had to pay for sex. There were many girls in their community who were readily available. When I asked if he used condoms, he scoffed, "Malinis naman sila. Mga pok pok lang kasi (They're clean. They're just pok pok.)."

I was flabbergasted. In my time, "pok pok" meant a sex worker, but apparently there's been a semantic shift so it now means females who don't necessarily charge for sex but who are available in exchange for a night out drinking. Because they're sort of free, they're seen as "clean."

Last Wednesday, I wrote that the AIDS epidemic in the Philippines, often described as "low and slow," might have shifted gears away from a low simmer to a slow boil. The concerns have been serious enough to spur UNAIDS, the Swedish Embassy and the Asian Development Bank to sponsor an AIDS summit in Manila earlier this week.

At that AIDS summit, Health Secretary Manuel Dayrit named the groups most vulnerable to HIV/AIDS: 500,000 to one million sex workers and their clients; 15.7 million young people aged between 15 and 24; 7.6 million overseas Filipino workers.

The figures, and the story of the "pok pok," got me thinking about how we urgently need more research on Filipino sexuality so we can project how HIV/AIDS might spread, and what we can do in terms of prevention programs.

Critical mass and velocity

Epidemiologists (scientists who study how diseases spread) often use terms from math and physics. Thus, you will find references to "critical mass," which in the case of an HIV/AIDS epidemic would be the pool of infected people who engage in risky sex, which means frequent unprotected sex with a constant change of partners. Once a critical mass is reached, the "velocity" of HIV spread could increase very quickly.

How might young adults contribute to the critical mass? In terms of numbers, their sheer size could mean serious problems. Unfortunately, our anxieties with young people focus mainly on premarital sex, to the point where we may have become blinded to the broader issue of irresponsible sex, whether in or out of marriage.

The 2003 National Demographic and Health Survey found that by the age of 19, one out of every five Filipinas has begun childbearing. I feel this is an even more important indicator of risk than premarital sex. Young people who have had their "coital debut" (first intercourse) may not necessarily be having regular sex, especially if they remain unmarried. I'm more worried about the young Filipinas who get pregnant early and are then marched off to get married.

These young couples could actually contribute to the critical mass for HIV/AIDS. Young husbands, especially if forced into an early marriage, are more likely to be having extramarital flings, exposing themselves and their young wives to sexually transmitted diseases. Yet, little is being done to educate these young couples about their risks.

Transactional sex

What about the sex workers? When "prostitution" is mentioned, we imagine the HIV/AIDS epidemic moving at a high velocity, in terms of frenzied activities in brothels, bars and massage parlors, each sex worker servicing dozens of partners each week.

I'd challenge those perceptions. An ongoing research project of Health Action Information Network (HAIN) found GROs ("guest relations officers") complaining about being suspended for not being able to reach a quota of three customers a week ... for "tabling," meaning customers who will just sit and drink with them. Similarly, massage parlor attendants complain that there are times when they may have no customers at all for a week or so. The brutal fact is that in the Philippines, the supply of sex workers outstrips the demand.

While government and NGOs concentrate on monitoring establishment-based workers through testing and campaigns to use condoms, we may be missing out on an even more vulnerable segment of the population: those engaged in transactional sex.

Many Filipino men may actually avoid the entertainment establishments because they're expensive. A cheaper alternative is transactional sex, involving freelance, part-time sex workers. These include students who may solicit clients in malls or out in the streets to supplement their allowances or to rush a tuition fee installment (thus the term "prosti-tuition"). In transactional sex, the financial remuneration may be quite low; in fact, sometimes the transactions will involve material benefits -- anything from a few bottles of beer, to clothes, to watches and cell phones -- rather than actual cash.

Those who engage in transactional sex (and these can include the pok pok) do not usually think of themselves as sex workers, and will rarely think of using condoms. We therefore have a potential here for rapid HIV transmission.

'Suki' and FB

Ironically, it may be our Catholic culture that creates this demand for transactional sex, as well as other varieties of risky sex. Because outright prostitution is seen as "sinful," our men create alternative arrangements to downplay the commercial angle. Thus, when they do go to entertainment establishments or pick up a freelance sex worker, they will go into "dating" mode, complete with courtship.

I call these "suki" relationships, where a customer returns to the same sex worker over several weeks or months, slowly transformed from a "guest" to a "boyfriend," or even a temporary "asawa" (spouse). What does this mean in terms of HIV transmission? On one hand, it does mean a reduced rate of partner change, which could slow down HIV spread. On the other hand, because the relationship has some semblance of a "boyfriend/girlfriend" arrangement, with illusions of fidelity, condoms could disappear from the equation, which means greater risks for HIV.

Confused? I haven't even started talking about FBs or f---king buddies. Like the suki relationship between a sex worker and a frequent-flier customer, FBs create some semblance of a monogamous relationship, without imposing any claims of commitment to each other. The risks for HIV exist because there will be change of partners, and condoms are again not used because the partners don't think of each other as sex workers.

There will be overlaps across FB, transactional and commercial sex, i.e., you can have someone working as a GRO at night, while supplementing her income with an occasional fling on the side as a pok pok and maintaining a special FB live-in relationship with a boyfriend from high school. What we see in these overlaps are dangerous "bridges" for HIV infections crossing over from one group to another.

Sex and the risks for HIV/AIDS involve more than acts. They involve a mazeway of perceptions, meanings, scripts, feelings about different partners, in different settings. The sooner we understand these mazeways, the better equipped we will be to handle the HIV/AIDS epidemic.

AIDS: Low simmer or slow boil?

AIDS: Low simmer or slow boil?


Posted 00:45am (Mla time) Feb 23, 2005
By Michael L. Tan
Inquirer News Service



Editor's Note: Published on page A15 of the February 23, 2005 issue of the Philippine Daily Inquirer


FOR the past few days, groups doing HIV/AIDS work in the Philippines-government, non-government, local and international-have been buzzing with activity, everyone busy preparing for a big AIDS meeting, now going on at the Mandarin Oriental.

No less than Pieter Piot is attending the meeting, he being the head of UNAIDS, an inter-agency body coordinating HIV/AIDS work throughout the world. The summit is co-sponsored by the Swedish Embassy and the Asian Development Bank.

I was asked to present a paper at the meeting but had to decline because of previous engagements. To make up for this, I promised my friends at UNAIDS a column summarizing my concerns around HIV/AIDS in the country.

Let me start by explaining why there's so much international interest in the Philippines. For several years now, AIDS experts have been intrigued by the fact that HIV-now affecting more than 40 million people worldwide-hasn't gone on a rampage in the Philippines. "Low and slow" is the way the epidemic is described in the Philippines. The Department of Health's AIDS Registry reports fewer than 3,000 cases. No doubt, there are many more unreported cases, but even taking under-reporting into account, the estimate is that less than one percent of the adult population is infected. Compare that to a prevalence rate of about 2 percent in Thailand and, in some southern African countries, of up to 33 percent-yes, 1 of every 3 adults.

Ideally then, we need to keep the epidemic at this low and slow level, because if it goes out of control, we know from the experience of other countries that the costs will be disastrous, adding to our already long list of economic and social woes.

Saliva and mosquitoes

It's clear that the epidemic in the Philippines may be low and slow because as early as the 1980s, shortly after HIV/AIDS was recognized as an international problem, our government and NGOs began to act. Some readers will remember intensive HIV/AIDS information campaigns in the past, with a deluge of seminars, workshops and educational materials.

Unfortunately, our efforts have slackened. These days, we rarely hear of HIV/AIDS except for the boring monthly updates reporting new infections, or an occasional sensational report in the paper of some sex worker having tested positive and gone into hiding.

The result? Public awareness levels of HIV seem to be on the downturn. The other week, in a research methods class I teach to seniors at the University of the Philippines, I used HIV/AIDS as an example for possible survey questions. When I asked the students if they thought HIV could be transmitted by mosquitoes, almost half of them actually thought this was possible.

The 2003 National Demographic Health Survey (NDHS), with a sampling of almost 14,000 women and some 5,000 men, gives us very alarming statistics concerning HIV/AIDS awareness. Nationwide, some 95 percent of respondents have heard about AIDS. But this awareness level varies across income groups and regions. For example, in the Autonomous Region in Muslim Mindanao (ARMM), only 75 percent of women and 51 percent of men had heard of HIV/AIDS.

Remember these figures apply only to awareness, meaning "having heard" of HIV/AIDS. When you get to specific knowledge about HIV, we have even more disturbing findings. Some 40 percent of women and 43 percent of men, for example, believe AIDS can be transmitted by mosquito bites. About 20 percent of both men and women believe AIDS can be transmitted by supernatural means.

Dangerous denial

The National Demographic Health Survey (NDHS) didn't ask people if they knew the difference between HIV and AIDS, but I've observed that even among university professors, there's still vagueness about the two terms. I'm not about to take chances, so let me explain the difference here: HIV means Human Immunodeficiency Virus, the microbe that causes HIV disease. Once infected with HIV, a person's immune system comes under attack but it does not necessarily mean he or she has AIDS or Acute Immunodefiency Syndrome. Without access to drugs to fight the virus, a person will, after several years, develop AIDS. But during the years of infection without AIDS-a time without any signs or symptoms-the person can pass the virus on to other people.

I'm mentioning all this because people continue to look for "signs" of HIV infection as if they existed. Sex workers, for example, will insist that they don't need to use condoms since they can tell if their customers are "clean." Conversely, the male clients of these sex workers will insist they don't need to use condoms if they get women from bars and beer houses that don't have foreign customers.

Periodically, we'll hear some radio talk show commentator calling for widespread testing for HIV. Again, this reflects ignorance about HIV/AIDS. The government already requires "entertainment workers" to be tested for HIV and sexually transmitted diseases (STDs), for which they're issued a health certificate. These certificates only lull people into a sense of complacency. The tests for HIV only detect antibodies to the virus produced after an infection occurs. The problem is that there may be a delay of several months before the antibodies are produced. This means a person may have already been infected but still test negative.

Discrimination

Ignorance about HIV/AIDS leads to denial about the risks of HIV/AIDS, and risky behavior. The NDHS figures show that people not only had misconceptions about the way HIV is spread but about prevention methods as well. For example, only 48 percent of women and 62 percent of men knew that condoms could prevent HIV.

Discrimination comes with denial. We dismiss HIV/AIDS as a problem "only" for sex workers and their customers. Or, if we hear about the rising infection rates among overseas Filipino workers, we think mainly of entertainers and seafarers. The reality is that HIV infections among overseas workers have been reported, too, among domestic helpers and nurses, and locally, among housewives, many of whom have been faithful to their husbands and who felt no need to protect themselves even if they suspected their spouses' many infidelities. As the expression goes, it takes two to be monogamous.

Discrimination drives HIV/AIDS underground, something to be discussed in whispers. And if someone does get infected, he or she will choose to be quiet about it, maybe even to remain in denial, because of the stigma around HIV. Our experiences in the Philippines and overseas have shown clearly that in a more accepting environment, care and support for people with HIV make them part of the solution, rather than exacerbating the problem.

Given the way denial and discrimination can fuel the spread of HIV, I wouldn't be surprised if the local epidemic has moved from a low simmer to a slow boil.

Ad-wise

Ad-wise


Posted 01:05am (Mla time) Feb 18, 2005
By Michael Tan
Inquirer News Service



Editor's Note: Published on page A15 of the February 18, 2005 issue of the Philippine Daily Inquirer


THE FIGURES are mind-boggling, so much so that they made the banner headline in BusinessWorld last week: "RP companies spend P113.26 billion on ads."

The figure comes from Nielsen Media Research, based on their monitoring of ads on television, radio and print. The P113-billion figure was for 2004, representing a 20-percent increase over the previous year's advertising expenditures, a very healthy growth rate when you look at the way other business sectors have been faring.

What does all this mean for the Philippines and the Filipino?

Mass media, mass reach

Any basic course in business will mention ads as being essential. Even the smallest sari-sari store "advertises" itself with a little sign, usually provided by a large company so that the sari-sari store's signage is itself transformed into advertising for some food or soft-drink manufacturer.

But in this age of mass media, we're interested in a much wider reach for advertising. Nielsen's figures show that television receives the bulk of advertising revenues: P82.2 billion or 73 percent of the total. Radio stations got P19.5 billion or 17 percent, while print media got the crumbs, about P9.6 billion or 8 percent.

Advertising and mass media go together-the ad companies aim for the mega-reach provided by radio, TV and print to get their clients' potential customers. Mass media, on the other hand, need the revenues to operate-broadcast media is basically free while newspaper sales and subscriptions are almost token in terms of supporting operating expenses.

Mass media's reach is overwhelming, literally reaching millions with each TV ad, the messages repeated through blitzkrieg campaigns, a kind of mental carpet bombing that may last only a few days, to be quickly replaced by a new campaign with fresh new messages. The goal here is to imprint on consumers a particular brand name.

Defining the good life

To get a brand name through to people, advertisements draw from culture: our notions of cleanliness, beauty, good health, nutrition and a "good life" in general. But even as they draw from popular culture, the advertisements reshape existing notions, transforming society itself, for better or for worse, especially in relation to particular needs-and wants.

From Nielsen's data, we learn the country's top 20 advertisers are: Procter & Gamble, Unilever, Colgate-Palmolive, Unilab, Nestle, Smart Communications, Fortune, Globe Telecom, San Miguel Brewing Group, Johnson & Johnson, Ginebra San Miguel, Pagcor, Whitehall, Mead Johnson, PLDT, California Manufacturing Corp., Universal Robina Corp., Monde Nissin, Jollibee and Tanduay.

We see then that the most advertised products are home-care products such as detergents and a range of personal-care products, including shampoos, soaps and skin care lotions. Other widely advertised products are medicines, cigarettes and alcohol, snack foods (including instant noodles), fast foods and telecommunications (cell phone-related services). And yes, there's Pagcor. Now I'm not quite sure how we should classify their ads as directly endorsing gambling or justifying gambling by showing how it supports social concerns.

Take time out to list the main messages you're getting through the ads, and you can actually get insights into what Filipino culture is like. I'll be random and list some of my own thoughts (some, of course, tongue-in-cheek), just focusing on the gender aspect. Notice the messages are often for women, recognizing that they do a lot of the buying for the family. (And if you listen hard enough, you'll find the voice-over, the one telling the women to buy, even "feminine hygiene products," is that of a man.)

A woman's most important assets, for getting a boyfriend, lover or husband, are her skin whitened with X brand and hair shampooed with X brand. (What is it about the Philippines and hair? Of the 10 most advertised brands in 2004, six were shampoos: Palmolive, Head and Shoulders, Pantene, Sunsilk, Rejoice and Cream Silk.)

Once you get that lover or husband, the sure-fire way of keeping him is using particular detergents and fabric softeners so his clothes look clean, smell clean. (But don't forget to feed him with instant noodles as well.) And when the kids start arriving, show you love them with certain infant formulas (especially those that claim to produce geniuses), vitamins, instant noodles, a cell phone.

Notice that the messages are often for women, on how to get and keep a man. Men, on the other hand, are urged to show their virility, through particular vitamins, cigarettes and alcohol. Even cell phones have brought in the "sexy male" image: one company shows a man holding a cell phone with screaming women dying to get their hands on him.

Life imitates ads

Ads don't just respond to needs; they're powerful for creating wants as well. They can distort priorities. Doctors always ask me why their patients will complain that they can't afford to take a particular medicine regularly and yet spend thousands each month on cell phones. We see that the telecommunications companies play on our basic human need to be in touch with other people, and amplify this to create new wants: don't be content with hearing your loved one's voice, get a phone with a camera so you can send your picture as well.

The advertising industry spends millions on research, including the use of social scientists to look into what's already out there, from people's primordial needs to the latest slang terms. But in the process, they literally fashion us to believe what is fashionable, from clothing styles to language itself. We may scoff at and spoof many of the ads, but don't forget that the more outrageously ridiculous they are, the deeper the product name recall.

In the end, ads don't just imitate life; we find ourselves living out the ads, buying the products with the hope of becoming a bit more like the advertising models with all the connotations of glamour and sophistication and sex appeal and social status. I've wondered how many night-time conversations have people imitating that ad for a vitamin claiming the product can keep a man's energy levels at a maximum, even if he's put in a whole day's work at the office. "Ako pa..." (loose translation: Me? Tired?), he claims seductively, suggesting he's ready for more "work," made indefatigable by the vitamin.

We need to teach our kids to be more "ad-wise," conscious of how ads manipulate our feelings and aspirations. But before we can do that, we need to be sure we are able to read through the ads as well, and reflect on how they do affect our lives, from what we serve on the table to the way we use our cell phones.

It's time we turned the table around and tell the advertisers: "Ako pa..." Me? I'm not that gullible. I'm ad-wise.

Balikbayan

Balikbayan


Posted 11:28pm (Mla time) Feb 15, 2005
By Michael L. Tan
Inquirer News Service



Editor's Note: Published on page A15 of the February 16, 2005 issue of the Philippine Daily Inquirer


LAST week, I had to pick up my mother from a hotel restaurant, where she said she was going to meet up with a distant cousin, a “balikbayan” [visiting overseas-based Filipino] now based in California.

I asked her how long it had been since she last saw him. "Since the end of the war," she answered casually.

So, I eventually met Uncle Lou, still a spry 75. It turned out he'd lived in Manila for a while longer after the war, migrating to the United States in 1955. In the last few years, he'd been coming back to Manila each year, but it was only this time that he looked up my mother.

I listened to him as he updated my mother on news from his end. Then he began asking about my mother's brothers and sisters, naming each and every one of them, and that, I can tell you, was a real feat because my maternal grandfather had so many children I still can't keep track of those uncles and aunts.

Earlier brain drain

Uncle Lou introduced me to his roommate, another balikbayan and a golfing partner. This one was Dr. Paul Luna, a pediatrician who graduated from the University of Santo Tomas and who left the Philippines in 1957. I realized he was part of the earlier brain drain, mainly of physicians and nurses.

Dr. Luna also visits frequently, but he was ebullient telling me about this latest trip where he joined a medical mission to Laguna that treated more than 3,000 people in a few days. The mission had been organized by the Michigan chapter of the Philippine Medical Association (I was amazed to know there were American chapters, and quite heartened to know they still maintained ties to the Philippines).

I told Dr. Luna about the current brain drain, now mainly involving nurses and caregivers, and how medicine was becoming a pre-nursing degree in the Philippines. He was surprised to hear about this new twist to brain drain.

I asked if he'd thought about retiring in the Philippines, and told him about the Philippine Retirement Authority, which helps balikbayan Filipinos and foreigners who want to settle down here in their old age. He hadn't heard about that office, so I think it should think about waging a more active information campaign to get to our balikbayan. (Technically, like Dr. Luna, they would now be considered foreign nationals since they would have become American citizens.)

But as we talked about retirement here, Dr. Luna did pause to think, and explained he had lived in the States longer than in the Philippines and that all his children lived there. I realized "home" for him was the States, but that at least he did think of coming back to the Philippines from time to time, and of serving with medical missions.

Roots

Meeting with Uncle Lou and Dr. Luna got me thinking. In our youth, we're more willing to explore new horizons, new worlds. But as we age, we think more of our roots, going back to ancestral homes, looking up long lost relatives.

Given the Filipino diaspora, that may not always be easy. What and where is home? How do we answer the classic Filipino question, "Taga-saan ka? [Where are you from?]"

I wonder at times about our claims to having close and enduring family ties. A few years ago while directing an anthropology field school in Bohol, I brought the students to the municipal cemetery and was surprised to find so many abandoned graves, some dating as recently as the 1980s.

The cemetery caretakers explained that the abandoned graves were usually those of relatives of Filipinos who had migrated. Bohol is well known as an out-migration area, and in fairness, I have to say Boholanos are quite conscious about maintaining ties with their hometowns, coming back to visit and donating books, medical supplies and medicines and setting up scholarships.

But we may have to face up to the fact that many Filipinos, once they migrate, will eventually think of America as their home. The idea of retiring in the Philippines is not too attractive, especially if their children live in the States. Some of my older relatives who now live in the States or Canada explain, too, that they feel more secure in North America with the medical system. There, with health insurance and retirement plans, they don't need to worry about their savings being wiped out if they come down with some catastrophic illness

Left behind

Sadly, it is this precarious life in the Philippines that may also push overseas Filipinos not just to stay abroad but to reduce ties with relatives back home to a minimum, to dodge the never-ending requests for financial assistance, usually associated with illness.

But I hope, too, that overseas Filipinos find ways of helping those left behind in the Philippines. Fr. Rudy Manoloto, a former student of mine who now ministers to a parish in the States, visited recently and I suggested that he appeal to his predominantly Filipino parishioners to be more conscious about relatives in the Philippines. I told him about several elderly Filipinos I know, within our own university community, living quite miserably despite having several children overseas.

Many overseas Filipinos do send monthly checks back to help their families, but tend to centralize the assistance with one relative, who presumably would take care of sharing the bounties. I'd advise our overseas Filipinos to pick that relative with great prudence. I know of families where the "chosen one" squanders the monthly checks on wine, women and song, even as their elderly parents suffer from grievous chronic illnesses.

We are now several decades into the Filipino diaspora, with Filipinos now living in all corners of the world. Their ties to the Philippines vary. Some will come home each year while others have not revisited since they left 20 or 30 years ago. Some left mainly because of economic reasons. Others were political exiles. Still others are "sexual" exiles (I know many lesbians and gay men who left because they could not live with the homophobia here). Still others feel countries in the West actually offer a better environment to raise their children in-how, indeed, does one raise a child to be honest when corruption is so pervasive, from the friendly neighborhood cop to the highest echelons of public office?

There are variations, too, among those who come home, the balikbayan. The classic stereotype is the whiner, endlessly complaining, in an American accent, about how nothing goes right here compared to Mother America. Others silently find ways to help out without being patronizing, sharing hopes that we will come to a time when Filipinos will still think of living and working overseas, but not as a desperate last option.

Heart talk

Heart talk


Posted 11:29pm (Mla time) Feb 10, 2005
By Michael Tan
Inquirer News Service



Editor's Note: Published on page A15 of the February 11, 2005 issue of the Philippine Daily Inquirer


IT'S February, the month of hearts, but I'm writing this column thinking about how each year, over the Christmas holidays, I have friends who succumb to cardiovascular diseases. This last holiday season I lost a friend, aged 52. The holidays of 2002 were particularly difficult: I had a close friend, only 48 at that time, who had a massive heart attack as well as one acquaintance who had a stroke. Both survived, but still another friend lost her husband to a stroke.

I've observed that the responses to these events have taken on qualities of religious moralism, with so much blaming and guilt feelings. The temptation to do that is especially strong in our culture, with our religious beliefs built heavily around notions of sin and punishment.

Over Christmas holiday feasts, the conversations inevitably drift toward naming the latest victims of heart disease. People around the table respond, "Yes, I heard," while staring down with guilt at a plateful of “lechon” [roasted pig]. In hospital corridors, relatives and friends shake their heads after visiting the victim, whispering about how so-and-so was such a heavy smoker, or lacked exercise.

The patient, too, goes through long and hard soul-searching, wondering what he or she did wrong. The mea culpas -- I have sinned, I have sinned -- are followed by a vow to be born again into a life without cigarettes and fatty foods, and more exercise but no sex, please.

Zealotry

No doubt, lifestyle changes are necessary both to prevent heart disease as well as to help survivors to recover. But I would warn, too, against the zealotry that emerges on the part of patients or caregivers, especially when they resort to fear tactics and victim-blaming.

We think that heart diseases strike because someone did something "wrong" but there are people, too, who lead perfectly healthy lifestyles but still get strokes or heart attacks. I have a very close relative who has had three transient ischemic attacks (sometimes known as "mini-strokes") within a few months, even if she rarely ate meat, walked at least a kilometer a day and never smoked in her life. It turned out she had a family history of strokes, and did tend to be a worrier. "Genes and nerves," her cardiologist told me.

But can you blame people for worrying too much? The colleague who had a Christmas heart attack had been suffering tremendous stress for several months because of workplace intrigues. People say he should learn to be more detached, but I wonder, given the viciousness of the intrigues, how anyone could just take things in stride.

I have to emphasize again that I believe in healthy lifestyles, but helping people to attain these lifestyles will require more than an appeal to guilt feelings. In the case of my relative who had the transient strokes, I started out with the very positive aspects of her lifestyle, pointing out that her long walks and fairly meatless diet probably helped her to avoid more severe attacks.

Taking good old aspirin was going to be important to help reduce her risks for more serious strokes, but we then tackled her being a worrier and we both acknowledged it wasn't going to be easy to just stop worrying. At the same time, there was much we could tap from her existing lifestyle. Her long walks were usually for going to Mass, but I pointed out that she could take walks for a timeout, in times of stress.

Heartless

I've noticed too how New Age therapies are coming into the picture: going vegetarian, doing yoga and meditation. Again, all that is fine with me, but I also worry at times about how these practices lose their original context of social compassion, and instead become very individualistic quests for health.

If I can take that observation a step further, I keep hearing stories about people who are vegetarian and who meditate and do yoga and tai chi and all that, and yet can be outrageously callous to people around them. In one office, people used to complain about one of their staff who would take over one of the rooms for her meditation and never mind people needing to use the room for their rest. If people dared, politely, to knock, she would snap, "Can't you see I'm meditating?" I'm sure she had a healthy heart, even if at the cost of breaking other people's hearts.

It's interesting, too, how some medical studies are disputing earlier research about Type A and Type B personalities. Originally, they thought that it was Type A people -- the assertive, aggressive workaholic types -- who were more prone to heart disease than the more laid-back Type B personalities. Now there are other studies suggesting Type A personalities may have fewer health problems because they express their frustrations, their anger, when they feel it. It's the humble and the meek, suffering in silence, that might end up with a heart attack.

To summarize, I often suspect that the most evil people in the world probably are at very low risk for heart disease because they know no guilt, know no remorse. Put another way, the issue of healthy hearts has no relevance for the heartless.

Elephants

All this talk about "learning to relax" and "avoiding stress" actually becomes absurd right after a heart attack or stroke, events which are themselves sources of tremendous stress. The friend who had a heart attack told me how, as he was wheeled into the emergency room, he felt like an elephant was sitting on his chest. After the doctors injected him with a drug for the heart attack, it was almost as if the elephant got up and off his chest.

But even as this was happening, he overheard the doctors warning his elder brother that if the heart drug failed, they'd have to resort to other measures, and that the cost could run to about half a million.

"Oh, Mike," my friend told me, "I could feel the elephant storming back in and jumping back on my chest." I can imagine he gets that feeling again, even if only of baby elephants, whenever he has to buy the many medicines prescribed to him.

One last anecdote here: I had to take over part of my friend's teaching load and administrative responsibilities, which has led people to warn me, "Hey, you might be the next one to get a heart attack. Relax naman." Easier said than done. The fact is that I would be more stressed out if I just shrugged my shoulders and avoided taking on the responsibilities.

Life's that way. If we are to be vegetarian, it shouldn't be just because of our hearts but because we respect life and want to avoid causing pain and suffering. If we take time off to relax and meditate, it should be to reflect on how we might become kinder, more helpful to people around us. For survivors of heart attacks and strokes, the attitude should be, "I survived. No sense regretting. Life must go on and I will live, more fully, for my friends and my family."

Take heart and live again, with a vengeance.

'Gongxi' or 'kungsi'

'Gongxi' or 'kungsi'


Posted 11:12pm (Mla time) Feb 08, 2005
By Michael Tan
Inquirer News Service



Editor's Note: Published on page A15 of the February 9, 2005 issue of the Philippine Daily Inquirer


THE OTHER day a friend told me she wanted her grandchild enrolled in a local Chinese school so he could learn Chinese, which she felt would be an advantage later on.

She's right, yet many Filipinos, including Chinese-Filipinos turn their backs on Chinese, which is offered not just in Chinese schools but, at the college level, for example, at the University of the Philippines.

Locally, the ethnic Chinese constitute only about 2 percent of the total population, but many own large and medium-sized business firms, so it's not unusual to see job advertisements looking for people who can speak Minnan Hokkien, the language spoken by most local ethnic Chinese or the Chinese national language Mandarin (the communist Chinese prefer the more proletarian name, Putonghua, which literally means "ordinary language").

Note that although there are 201 living languages in China, as listed in the Summer Institute of Linguistics' website, most of these use one common script, which has been an important reason why such a large country has stayed unified.

Because of the sheer size of China's population (some 1.3 billion), Putonghua is currently the world's most widely spoken language. To be able to speak Putonghua can mean access to many opportunities, especially with China developing so rapidly.

Putonghua isn't limited to China alone. It's also spoken by many overseas Chinese and is sometimes referred to as Huayi, the language of the "Hua" or Chinese. Many times, in cities as diverse as Bangkok and Bristol, Singapore and Salvador, I'd enter a restaurant or a shop and as soon as I'd have an inkling that the owners might be Chinese, I'd say something in Chinese. Like a magic mantra, I'd find myself getting hefty discounts, special tables in restaurants and dishes not listed on the menu and, quite simply, new friends.

A musical language

Business, shopping and friendships aside, Chinese is worth learning for its own sake. It is a language that is as complex as it is fascinating. Like many Asian languages, most Chinese dialects are tonal, meaning the pitch with which it's spoken determines differences in meaning. In Putonghua for example, depending on which tone is used, "ma" can mean "hemp," "to scold," "mother" or "horse,"

Learning these tonal languages early may have an unexpected benefit. Psychologists at the University of California in San Diego recently released results of research showing that children who learned Putonghua as babies were far more likely to develop perfect pitch than those who were raised to speak English. Perfect pitch is the ability to name or sing a musical note, and is considered to be relatively rare, with only 1 in 10,000 Americans having this gift.

Imagine that, being able to speak Putonghua giving you the advantage of being able to do business with the Chinese, including being a hit at karaoke, which is immensely popular in China. (I have to say, though, my memories of karaoke in China are as unpleasant as those of karaoke here, or maybe it's just that karaoke, in Manila or Beijing, tends to attract those with the most imperfect musical pitch.)

Idea words

Some of you might be asking which Chinese language would be most useful. Hokkien? Putonghua? Cantonese? I'd still suggest Putonghua because it is the national language, and I'd add that you might want to learn to read and write Chinese as well. I've mentioned that one common script is used all throughout China, so whether you're in Hong Kong or Beijing, you can make your way around if you can read the written form. The bad news is that Chinese does not use an alphabet and instead uses thousands of ideographs, which I'll explain shortly.

There have been many attempts to try to Romanize Chinese, meaning get the words spelled out with the Roman alphabet. The title of my column shows two versions of the greeting "Wishing you happiness," which you can use today, Chinese New Year, and on other occasions, from birthdays to graduations. In China today, there is one system called pinyin which has tried to standardize the Romanized versions of the sounds. "Gongxi" is the pinyin version while "kung si" is a Romanized form from another system.

Unfortunately, you can't get by with these Romanized systems. First, the tones have to be learned. Second, the same Romanized word may refer to many different ideographs.

How many ideographs would one have to learn? You could get by with a thousand, but someone truly fluent would know much more. I'm a novice at this, despite several years of Chinese classes at Xavier School, but I've found that learning to read and write Chinese is a lifelong experience... and a voyage of discovery.

Ai

Ideographs are fascinating because you can break them down into their components and, in the process, quite often you learn something about Chinese culture. The character for a male, nan, shows a rice paddy on top and "strength" on the bottom, showing how maleness was defined in an agrarian society. On the other hand, nu, the character for a female, shows a person kneeling, reflecting the feudal low status assigned to women in the past.

The ideograph for a female, when combined with other characters to form other words, speaks volumes about Chinese gender concepts. A female under a roof gives you the word anor, “peace.” Combine "female" with "child" and you have the word hao, which means "good," reflecting the importance of bearing children.

Even if you don't plan on learning Chinese, I'd suggest you pick up "Analyzed Ideographs" by Tinna K. Wu at National Bookstore (the author once lived in the Philippines and went on to become a Chinese language professor in the United States). I have so many favorite examples from her book but I particularly enjoyed the section where she shows how repeated use of the same character generates amazing new ideographs. For example, put three hands together into one word and, goodness, you’d know the feeling if you've lost your cell phone to ... a pickpocket!

With Feb. 14 just around the corner, let's do a bit of analysis around the heart. In Chinese, if you write out the character xin or "heart" three times, you produce the word suo, which means suspicious. Note how in many Asian languages, "heart" refers both to feelings and to thoughts so the message here is that sometimes, maybe around Valentine's especially, we shouldn't bog ourselves down with too much heart.

On the other hand, there's wisdom in the way the Chinese combine the word shou, which means "to endure" with xin, the heart to produce ai. On its own, endurance often means a quiet suffering. But insert the heart-feelings and thinking-and no longer do you just endure, but you have ai, or love. In explaining the construction of the Chinese ai, Tinna Wu, a pastor's daughter, brings East and West together by quoting from 1 Corinthians 13:4: "It suffers long, and it is kind ... It endures all things."

Pilgrimages of faith and reason

Pilgrimages of faith and reason


Posted 01:10am (Mla time) Feb 04, 2005
By Michael Tan
Inquirer News Service



Editor's Note: Published on page A15 of the February 4, 2005 issue of the Philippine Daily Inquirer


BACK in September, I wrote about the controversy revolving around a proposed musallah or Muslim prayer room in the Greenhills Shopping Center, with some Greenhills residents protesting the construction of the prayer room, which they initially claimed was going to be a mosque. Scenarios were painted of Greenhills' property values plummeting as a Muslim "mosque" would draw in crooks and terrorists.

The campaign against the musallah, I felt, was a blatant case of religious bigotry. The shopping center has an estimated 400 Muslim traders, most of whom don't actually live in the area but who, in fulfillment of Muslim religious obligations, need to be able to pray five times a day. For years now, even before the construction of the musallah, the traders had been using a dark alleyway within the shopping center as a makeshift prayer area.

It was good to read that Ortigas and Company, which runs the shopping center, held its ground and pushed through with the construction. It was also appropriate that the new musallah opened on Eid Adha, marking the end of the Haj or annual pilgrimage to Mecca. The symbolism is striking, of pilgrimages revolving around faith and reason.

A triumph of reason

Let's go back to the musallah controversy. It was unfortunate that print and broadcast media seemed to have given more coverage to the opposition. Less visible were the Greenhills residents (I count myself as one of them since I'm frequently at my parents' place, which is in the area) and San Juan officials, including Mayor Joseph Victor Ejercito, who decried the religious intolerance and pushed for the musallah to be built.

The construction and opening of the musallah marks the triumph of reason over ignorance. We've suffered enough from bigoted Christians who propagate negative stereotypes of Islam and Muslims. If the musallah had been denied, that would have been used by the more extreme Islamist groups to recruit new members by pointing to this instance of Christian intolerance as a reason for jihad or holy war.

To their credit, Catholic and Protestant leaders spoke out against the prejudice surrounding the Greenhills controversy. Even Masses at the Catholic chapel in the Greenhills Shopping Center were temporarily suspended at the height of the controversy, as a way of expressing solidarity with the Muslims.

All these developments show that the Christian-Muslim "problem" is surmountable. Reason can prevail here, recognizing that the two religions are very different, and yet can coexist through shared values, especially that of mutual respect.

I always felt uncomfortable seeing the alleyway where the Muslims used to pray -- it was dark and dank and dingy, not a pretty sight for Christian passersby. The musallah gives decent space to Muslims and, who knows, might even become a way for Muslims to explain their faith to Christians.

Haj

The new musallah's inauguration coincided with the end of the Haj. That pilgrimage is one of the five pillars of Islam, a profession of faith required of every able-bodied Muslim who can afford to do so. Ideally, a Muslim should be able to make the pilgrimage at least once in a lifetime.

The Haj is shrouded by all kinds of symbolism and meaning. In the first part of the pilgrimage, the umrah or lesser haj, all pilgrims must wear sandals and the ihram, a white unhemmed cloth draped over the body, representing equality of all pilgrims.

Pilgrims have fixed itineraries, moving from one place to another, each with its own meaning-laden rituals. The most publicized is the stoning of the devil in the city of Mina, just outside Mecca. Three pillars, representing Satan, are "stoned" (with pebbles actually). In this year's Haj, there was a modification as pilgrims stoned US President George Bush, seen, presumably, as the devil incarnate.

The Haj is an amazing religious event, in many ways defining the life of a Muslim. The trip, for example, is done only after a Muslim has settled his or her worldly affairs. This means the Haj is not only a pilgrimage toward a place, but itself becomes a goal: stabilizing one's life is a process oriented toward being able to do the Haj eventually. After the stoning of the devil, pilgrims shave their head (women cut off a lock of their hair) as a symbol of rebirth.

Pilgrimages take added significance from the difficulties and sacrifices associated with the journey. Besides the long trip, the stay in Mecca is itself surrounded by risks. In past years, hundreds of people died during the Haj because of fires and stampedes in the pilgrimage sites. There can be no interruptions to a Haj -- once started, it must be completed.

This year's Haj took more poignant significance because the deadly tsunami that struck in December 2004 happened just as the Haj started. Many of the pilgrims were from areas in Indonesia and Thailand that were affected by the tsunami; yet, the pilgrims pushed on with their trip to Mecca. It's not surprising that Mecca has become a universal metaphor, used even by Christians, to refer to a difficult but extremely desirable goal or destination.

Two pilgrimages

The parallels between the Greenhills musallah and the Haj are striking. The Greenhills controversy was similar to the hardship one faced in going to Mecca. The Haj is a pilgrimage of faith, while the Greenhills imbroglio was a pilgrimage of a different sort, a search for -- and a triumph of -- reason.

Pilgrimages always involve groups brought together by common aspirations. The Haj has always been an occasion for a display of a most dramatic form of community, that of the ummah, the idea that all Muslims are part of a global community. The struggle to build a musallah in Greenhills showed another side to the notion of community -- here of diverse groups seeking each other out, each with their own space but standing side by side.

We should learn from the Greenhills musallah. For example, other shopping centers with large numbers of Muslim merchants should think of providing similar space. I hope, of course, that there will be more interfaith discussions, rather than just prayer spaces and that with time, as Christians and Muslims practice their faith, side by side, we might all find convergence.

Remembrances of scents past

Remembrances of scents past


Posted 01:20am (Mla time) Feb 02, 2005
By Michael Tan
Inquirer News Service



Editor's Note: Published on page A13 of the February 2, 2005 issue of the Philippine Daily Inquirer


WHAT would life be like if we described the odors around us in a dichotomy: “mabango” (good smelling) and “mabaho” (bad smelling)? Simpler, yes, but oh so much more dull.

So in Tagalog we've come up with many more olfactory terms: “mabantot,” “mapanghi,” “masangsang,” “malansa,” “mahalimuyak” and many more adjectives. I'm not going to even attempt to translate those into English, inviting my foreign readers to ask Filipinos to describe the fine nuances around each term. Limiting ourselves to the "ma-" Tagalog smelly adjectives alone, we could easily generate more than 20. If we use "amoy" as a suffix, for example, "amoy-baby" (smells like a baby), the possibilities expand to infinity.

We tend to sniff and smell everything, from the food we pick up in the canteen to people around us. Having done that, we then resort to our linguistic arsenal to pass judgment on the smells. Certainly, we're not the only smell-oriented society in the world, but it's fascinating to look at how Filipinos deal with smells.

Social smelling

Smells divide and distinguish us from others. The upper classes use odors to distinguish themselves from the unwashed masses (note the English use of that term, which comes close to being smell-oriented) as women do of men (and, not as rarely as you think, men of women). Filipinos are notorious, too, for using smells to put down other ethnicities. My students have mentioned, for example, "amoy Kano," "amoy Arabo," even "amoy Intsik." When I perk up and ask, in mock indignation, what amoy Intsik is, they beg off, saying it's difficult to describe. You know it's “amoy Intsik” when you smell it, I am assured, but I have not been able to decipher the term, at least not by sniffing myself.

Unfortunately, for all our self-consciousness around smells, we don't usually know what we smell like, except when we're truly exhilaratingly ... or abysmal. Smells are eminently social, becoming meaningful only when at least two people are involved. I said earlier that smells divide, but they bring people together, too.

Like the Americans, Filipinos practically shower in colognes and perfumes. For lower-income groups, heavily scented soaps are preferred since they substitute for the more expensive scents. The exaggerated smells seem to work as mating calls; several of my male friends claim they've been approached by women who ask, "Is that Paco Rabanne you're using?"

Now if you successfully snare someone with that olfactory pickup line, you might find yourself describing him later to friends with the superlative, oh he is so “mabangong mabango.” I'm not sure it works out as appropriately in English, to describe the love of our life as "smelling so good."

Evocative smells

Let me repeat here that we're not the only smell-oriented culture. In fact, I'd say that all humans attach importance to smells, although the degree of cultural expression varies. If I can shift to biology here, across millions of years we gradually lost our sense of smell relative to many animals. Look at dogs: they use smells to locate food and friends, to mark territory (male urination), to find or attract a mate. With humans, as we developed our complex brains, the sense of smell became less prominent in our lives, giving way to sight and hearing.

Nevertheless, we would have gone extinct if we had completely lost our olfactory sense. Smells allow us to detect danger (I have no doubts that in our ancient hunting gathering past, our ancestors could smell the prey, as well as smell enemies from afar). Today in the 21st century, we still use our sense of smell for more mundane activities, like checking the food if it's spoiled.

The title of my column today takes off from French novelist Marcel Proust's "The Remembrances of Things Past." Smells are powerful in evoking memories, and in a very specific way. The smell of spoiled mussels for example reminds us of the explosive diarrhea we had when we ate something similar 20 or 30 years ago, warning us, "Don't eat."

It wasn't surprising that the 2004 Nobel Prize for medicine went to Richard Axel and Linda Buck for their research on the sense of smell. This is not the place to go into details but briefly, the two researchers discovered the gene pool containing blueprints for sensors in the nose. They were able to unravel the way we discriminate smells, the average individual able to recognize up to 10,000 separate odors.

Culture and smells

As an anthropologist, I'm fascinated by the way biology binds us together across cultures, so that certain smells are almost universally attractive or universally repugnant. At the same time, there's a whole multitude of smells that elicit different reactions in different cultures. Generally, new or unfamiliar smells seem to set off defense reactions. Before the cultivation of Mediterranean herbs became popular here, I took sprigs of rosemary to a class at the University of the Philippines and passed it around. Most of my students at that time reacted negatively, "Ugh, mabaho." These days, with the fad around aromatherapy and herbs, more Filipinos react positively.

Generally, Filipinos prefer strong scents in colognes and perfumes and in air fresheners. Which can be a problem for people like myself, who prefer more nuanced scents. I find air fresheners an assault on the sense of smell, especially the ones in cars, which I find too acrid, “amoy ihi” (smelling of urine). There really ought to be a law requiring public establishments to ask the permission of clients before they spew out noxious fumes, which are now known to be serious enough to cause migraines in people who are extra sensitive to smells.

My point is that there are cultural differences in the way we smell, and describe those smells. English is relatively poor in olfactory terms, using more similes ("You smell like..."). Despite this relative linguistic poverty, the power of scents still wafts through English. I never forgot an article in the International Herald Tribune describing the Paris Metro (subway) at the end of the day as "smelling of day-old sweat." The phrase has returned to haunt me many times late in the afternoon, at the most unguarded moments, when I'm on Manila's Light Rail Transit or in the lobby of Palma Hall at the University of the Philippines. Mind you, it's neither pleasant nor unpleasant, this day-old sweat smell, but it does evoke, for me, memories of good times with friends, of my own student days.

Maybe I'm being too ethnocentric in saying English is linguistically poor when it comes to odors. Whatever the language, a good storyteller, a good writer, should be able to draw on whatever's available to capture, even if only weakly, the scintillating, the sensuous, the sensual in our scents.