About resident doctors and the PH government hospital system

Earlier this month, Ms. Fely Viloria Sicam wrote an opinion piece (titled "Are resident doctors really doctors?") in her column "Loud Whispers" in the Mindanao Times.

Ms. Sicam's article and her subsequent letter to the editor after reading about the various negative reactions to her piece have (as of this writing) been taken off the Mindanao Times website, but photos of the printed versions are available on various Facebook posts and on blogs such as this: http://heavenpurgatoryandhell.blogspot.com/2015/07/dear-ate-fely.html

A respectful response from a colleague and friend, Dr. Adrian Paul Rabe, was published by Rappler: http://www.rappler.com/move-ph/ispeak/100143-open-letter-resident-doctors

Other responses of other doctors are easily found on Facebook and elsewhere with the right search keywords.

As a UP-PGH alumnus, I am acutely aware of many of the difficulties that resident physicians face each day. While I share the outrage of my medical colleagues because of the inaccuracies stated by Ms. Sicam, she does help raise awareness of the poor conditions of our public/government health facilities and the urgent need to improve them. Indeed, as some colleagues have suggested, it should be mandatory for government officials (particularly the President, Vice-President, cabinet secretaries, senators and congressmen, and members of the judiciary) to consult, be treated, and/or confined only at government hospitals.

After a bit of research, I found Ms. Sicam's FB account and sent her this message:

Dear Ms. Sicam,

I know of you only through the op-eds you wrote recently about nurses and resident doctors in our poorly equipped and understaffed government hospitals. I also read your letter to the editor about the vitriolic reaction to your articles and your wondering why there was no reaction posted on your FB account. I think the answer is simple. When I searched for "Fely Sicam" and "Fely Viloria Sicam" on FB, your FB account did not show up. I was only able to find your FB account after doing more research and finding out your full first name is "Felicitas". That said, you can easily see the various posts reacting to your articles by searching in FB for "Fely Viloria Sicam".

If you are truly the journalist you claim to be, you should not be overly dismayed by the reactions to your articles. You wrote a public opinion; you should be willing to accept any and all reactions, good or bad, to what you wrote. (Objectively though, you really should have done better research and used impeccable English, particularly since you commented on the non-use of English by the ER staff.)

Also, it seems that the Mindanao Times has removed your articles (at least those we are talking about) and your letter to the editor from its website. If this was intentional, then there is little to be said about the transparency and fearless journalism of that media outlet. That is of little consequence though, as photos of your articles and letter have already made their way into social media, immortalizing your words on the Internet.

If I were you, I would insist that the op-eds be returned by the Mindanao Times to its website, as you do bring to light the dismal condition of our government hospitals, which really do need much improvement. In the bigger scheme of things, it is this systemic problem that needs to be fixed. As to the "inaccuracies" in your articles, a public apology may be necessary, but this is merely my suggestion.

Sincerely,
Ulysses Dorotheo, MD, FPAO

No safe level of lead exposure

Reposting from the Ecowaste Coalition blog http://ecowastecoalition.blogspot.com/2015/05/use-lead-safe-paints-for-brigada.html

‘Use Lead-safe Paints for Brigada Eskwela Renovations,’ Organizers Told

Quezon City. Two weeks before classes resume on June 1, an environmental watchdog has reminded Brigada Eskwela organizers and volunteers nationwide to observe lead-safe work practices as public elementary and secondary schools undergo repair and renovation.

“The annual Brigada Eskwela provides school communities a great opportunity of promoting lead-safety consciousness among the participants of various cleanup and makeover activities,” said Jeiel Guarino, Lead Paint Elimination Campaigner, EcoWaste Coalition.

“The prevention of the toxic risk posed by lead in paint, dust and soil should be prioritized in every Brigada Eskwela operation as it poses grave threat to the well-being of young children,” he said.

“Oil-based enamel paints containing lead are still being sold in the market. Lead is a neurotoxin that damages children’s mental, cognitive and behavioral development—and thus, must not be used at all in schools and other places frequented by children,” he added.

Guarino also emphasized that improper removal of leaded paint in school classrooms and facilities should be prohibited in Brigada Eskwela activities as the lead dust that may be created from these renovation activities may cause serious health problems for all participants, with the children at highest risk of exposure through accidental ingestion due to their normal hand-to-mouth behavior.

The World Health Organization (WHO) has described exposure to lead through ingestion, inhalation and, sometimes, through skin absorption as being “irreversible” and “untreatable,” and has listed lead as one of the “ten chemicals of major public health concern,” estimating that childhood lead exposure contributes to about 600,000 new cases of children with intellectual disabilities every year.

Towards a lead safe Brigada Eskwela, the EcoWaste Coalition recommends the following basic precautionary steps:

1. Use lead-safe paint for school interiors, exteriors, furniture and fixtures. Specify lead-safe paints for donations from individuals and institutions.

2. Keep children and pregnant women out of the work area, as lead is very hazardous to unborn children.

3. Do not disturb lead painted surfaces in good condition.

4. Cover cracked or deteriorated surfaces with lead-safe paint. Do not dry sand or dry scrape painted surfaces.

5. Wet sand or wet scrape if desired or needed. Use a spray bottle or wet sponge to keep the surface damp and the airborne dust levels low.

6. Do not eat, drink or smoke in the work area.

7. Work clean: create little dust as possible, clean up thoroughly and dispose of paint waste properly.

8. Thoroughly wash hands with soap and water after any repainting work.

9. After a repainting job, change clothes before going home, set aside in a sealed reusable bag and wash separately.

-end-

For a more comprehensive information about lead safe work practices, please refer to any of the following resources:

http://www2.epa.gov/lead/lead-safe-certified-guide-renovate-right-2
http://portal.hud.gov/hudportal/HUD?src=/program_offices/healthy_homes/lbp/hudguidelines

Happy birthday, FCTC!

My op-ed on the 10th anniversary of the WHO FCTC. "In 2005, when the FCTC came into force, the world’s nations united in saying it cannot be business as usual for the tobacco industry."

http://www.bworldonline.com/content.php?section=Opinion&title=vanquishing-the-tobacco-scourge-still-a-long-way-to-go&id=103714

Vanquishing the tobacco scourge: Still a long way to go

THE WORLD Health Organization Framework Convention on Tobacco Control (FCTC) turned 10 last Feb. 27. Given that tobacco kills six million people globally every year, the importance of celebrating this treaty cannot be over-emphasized. Today, there are 180 State Parties to the FCTC, committing themselves “to protect present and future generations from the devastating health, social, environmental and economic consequences of tobacco consumption and exposure to tobacco smoke.”

In 2005, when the FCTC came into force, the world’s nations united in saying it cannot be business as usual for the tobacco industry. Over the past decade, the world has seen many local and national governments banning smoking indoors and in workplaces and even some outdoor public places (including the Olympics and Southeast Asian Games), as well as banning tobacco advertising and promotions in mass media and at points of sale, including the retail display of tobacco products. Many countries have also banned or restricted the tobacco industry’s fake corporate social responsibility (CSR) schemes, acknowledging that an industry that inherently harms society can never be deemed socially responsible.

Regular excise tax increases that make products increasingly less affordable are also slowly gaining ground in all regions of the world based on the recognition that taxation is not only a revenue measure but also an important public health measure that encourages current smokers to quit and discourages youths from starting to smoke. Notably, within ASEAN, excise was increased by more than 300% in Brunei (2010) and the Philippines (2013). Additionally, excise surcharges have been dedicated by law to fund tobacco control in Thailand, Laos and Vietnam, while in the Philippines, incremental excise revenues are earmarked for universal health coverage and alternative livelihoods of tobacco farmers and workers.

Health warning labels have also come a long way, from absent or tiny text-only warning on the sides of packages to large pictorial warnings on the front and back of packs in more than 75 countries, with Thailand currently having the world’s largest (85%) pictorial warnings. In Australia, standardized or plain packaging enhances these graphic warnings by removing the attraction and glamor of colorful branded packages.

These are all consistent with the various evidence-based implementation guidelines that the FCTC Conference of Parties (COP) has adopted over the past several years, but 10 years later, we need to ask: are we on track to end the tobacco epidemic and its profoundly negative consequences, not just on the health of individuals, but also on human rights, social development, national economies, and the environment? Have we begun to see a decline or even a slowing of consumption in developing countries? Are the poor smoking or chewing less tobacco? Are the tobacco industry’s profits declining?

Unfortunately, smoking prevalence is still high in many countries, and cigarettes remain very affordable, including in all ASEAN countries. Consequently, the number of tobacco users and deaths continues to rise, while the tobacco industry, the vector of the epidemic, continues to make obscene profits at the expense of public health: in 2013 the profit of the four biggest companies was over $36 billion.

So while the FCTC has accelerated tobacco control progress in many countries, a more serious effort is needed to achieve the global target of reducing tobacco use prevalence by 30% by 2025 (This target was adopted in 2013 by the World Health Assembly as part of the Global Action Plan for non-communicable diseases, and subsequently by the FCTC COP in 2014.).

Based on global and country reports submitted to the COP, two of the main challenges identified are tobacco industry interference in policy development and implementation, and limited resources in countries for tobacco control. A large focus therefore must be to enlighten misguided policy makers, government officials, and media practitioners, who continue to defend industry positions, so that regulations can be as strong and effective as possible and to ensure that adequate human and financial resources are allocated to FCTC implementation at both national and global levels.

At the national level, tobacco control needs to be prioritized if countries are to tame the exponentially growing non-communicable diseases burden; without tobacco control, it will be impossible. This requires a whole-of-government approach, possibly framing tobacco control as a national development priority, so that ministries of finance, education, social welfare, agriculture, labor, and trade must support tobacco control, not just ministries of health.

Local governments also have a large role to play in implementing and enforcing smoke-free policies and educating their constituencies.

Expectedly, the tobacco industry will continue to interfere, aiming to defer, dilute and delay effective regulation. It is necessary therefore to continue raising public awareness of such tactics and working to denormalize the tobacco industry. Governments need to hold the tobacco industry accountable for the devastating consequences of its products, and -- a related issue -- implementation of FCTC Article 5.3, calling for governments to refuse to cooperate with the tobacco industry in formulating health policy, should be a priority in all countries.

At the global level, nations need to look seriously at accelerating FCTC implementation, so that the tobacco death clock can begin to slow down. Within the post-2015 Sustainable Development Goals, non-communicable diseases are shaping to be a priority, so this is good news, as long as global leaders remind themselves that tobacco is a major risk factor for the four major non-communicable diseases and that FCTC implementation should be a priority within the non-communicable diseases priority. Additionally, tobacco’s social, economic, and environmental harms should also be covered.

Ten years of the FCTC is a good number to celebrate, but let’s hope it doesn’t take another 10 to see even faster progress. Six million preventable deaths per year is six million too many.

Dr. E. Ulysses Dorotheo is the FCTC program director of the Southeast Asia Tobacco Control Alliance (SEATCA) and currently sits as chair of the board of the Framework Convention Alliance, a global NGO of close to 500 member organizations.