If I remember it right, it’s been already a decade of almost nonstop controversy regarding the reproductive health and contraceptives issue. The earliest that I could remember was how Mayor Lito Atienza came under fire for banning Manila public clinics from distributing free contraceptives and teaching any other methods of contraception other than natural family planning, which is the only “contraception” method espoused by his religion. Human Rights Watch HIV program research, Jonathan Cohen, even went far in saying that “the Philippines is courting an AIDS epidemic with its anti-condom approach…the casualties will be millions of people who cannot protect themselves from HIV infection“. Lito Atienza and his wife may have had pro-life projects that truly helped impoverished women, especially those who suffered from post-abortion trauma, but still, their anti-contraceptiion stance is immovable.

And such stance has pervaded, unfortunately, some of the country’s lawmakers. For this reason, the fate of the Reproductive Health Bill, hangs in a balance.

And unfortunately, the anti-RH force is moving heaven and earth just so that this bill will not be passed.

But what is it in the Reproductive Health Bill that has enraged the Catholic clergy?

I have actually written about this particular subject several years ago (see “What the RCC hates in the RH act“). But, since this bill has gone some revisions, we shall try to review it again, during the course of which I’ll try to dismantle the misinformation being propagated by the so-called “pro-lifers” (who have more than successfully hijacked the term just so to gain unfair advantage over their opponents).

The elements of reproductive health care that are being espoused by the bill are as follows:

family planning information and services;
maternal, infant and child health and nutrition, including breastfeeding;
proscription of abortion and management of abortion complications;
adolescent and youth reproductive health;
prevention and management of reproductive tract infections (RTIs), HIV and AIDS and other sexually transmittable infections elimination of violence against women;
education and counseling on sexuality and reproductive health;
treatment of breast and reproductive tract cancers and other gynecological conditions and disorders;
male responsibility and participation in reproductive health;
prevention and treatment of infertility and sexual dysfunction;
reproductive health education for the adolescents
mental health aspect of reproductive health care.

But for this post, I shall be limiting myself in those concepts that has lighted the fire under our beloved clergy’s butts.

1) Family planning information and services

Beloved Catholic clergy did not want taxpayers’ money to fund public health clinics giving out pamphlets and lectures regarding modern artificial contraceptives. Neither does it want it to be giving away free contraceptives. The clergy wanted ONLY natural methods of family planning to be endorsed and taught by these clinics. The clergy has successfully convinced some of its members to disagree with the bill by cleverly insinuating that their taxes go to activities deemed immoral by their church (not considering that NOT everybody in this country belong to their church). And so the statements, “I will not allow the government to use my taxes to pay for your condom” and “let them buy their own condoms”. Well, the idea is to help out the impoverished who cannot afford to buy contraceptives. For those who do not know, contraceptives are considered essential medicines (see section 18, WHO list of essential medicines March 2010 update). The WHO list of essential medicines is a list of minimum medicines needs for a basic health care system. If the clergy wanted to prevent contraceptives from being able in a basic health care unit, then they are, basically, preventing the government from addressing basic health care needs.

The clergy is also frowning upon the use of IUDs and tubal ligation as contraceptive measures. What most of them are blind to is the provision in the bill that these procedures will not be FORCED upon women, but rather, it would be made available to those who may wish to have these procedures.

SEC. 7. Access to Family Planning
All accredited health facilities shall provide a full range of modern family planning methods, except in specialty hospitals which may render such services on an optional basis. For poor patients, such services shall be fully covered by the Philippine Health Insurance Corporation (PhilHealth) and/or government financial assistance on a no balance billing.
After the use of any PhilHealth benefit involving childbirth and all other pregnancy-related services, if the beneficiary wishes to space or prevent her next pregnancy, PhilHealth shall pay for the full cost of family planning. 

SEC. 11. Procurement and Distribution of Family Planning Supplies
The DOH shall spearhead the efficient procurement, distribution to LGUs and usage-monitoring of family planning supplies for the whole country. The DOH shall coordinate with all appropriate LGUs to plan and implement this procurement and distribution program. The supply and budget allotment shall be based on, among others, the current levels and projections of the following:
(a) number of women of reproductive age and couples who want to space or limit their children;
(b) contraceptive prevalence rate, by type of method used; and
(c) cost of family planning supplies.

SEC. 24. Right to Reproductive Health Care Information
The government shall guarantee the right of any person to provide or receive non-fraudulent information about the availability of reproductive health care services, including family planning, and prenatal care.
The DOH and the Philippine Information Agency (PIA) shall initiate and sustain a heightened nationwide multi-media campaign to raise the level of public awareness of the protection and promotion of reproductive health and rights including family planning and population and development.

2) Proscription of abortion and management of abortion complications

As early as now, I’m going to say there is nothing (I repeat, NOTHING) in the reproductive health bill that is espousing abortion (abortion being “expulsion from the uterus of the products of conception before the fetus is viable”, according to an online medical dictionary). The bill, rather, wants to strengthen postabortion care. Now, some will say this is indirectly encouraging women to have abortion. But I’m going to stop you right there. Every woman who has had an abortion, whether spontaneous or induced, whether the abortion hurts you as a believer or not, has a right to obtain good postabortion care.

I remember how it was in the different hospitals I have rotated before…girl coming to the hospital complaining of vaginal bleeding and by history, it was evident that she had induced abortion. Health care providers, then, would be rough and tough on her, just so she’d remember the pain and thus, “remember the lesson”. And some even threatened to be denied anesthesia during curettage, just so they’d break down and cry, the health care provider thinking she’d someday learn to keep herself from getting pregnant again, having more than 5 children or so at the tender age of 20. I remember crying at the time I assisted in the vaginal delivery of a 12-year old girl, a pregnancy that was a product of rape of her father. I remember her as a pained girl, who was so restless on the delivery table, not knowing what to do and too much in pain even to think, as the ob-gyne resident shouted down on her to keep her legs apart. “Ayoko na po! Ayoko na po!” were the words she had ceaselessly shouted until she was able to deliver her baby. I imagined it must be the same set of words that she have shouted back to her father while she was being raped.

No, I’m not saying that this girl should have outright abortion because of rape. But if reproductive health assistance are in place, she could have had proper prenatal care and a planned cesarean section would have been done, as her body frame is so small, she might be better off with a C-section rather than risking a vaginal delivery. However, she did not have prenatal care and the only consultation with a health professional that she had was when she was already in active labor. Or she could have had emergency contraception hours after the attack on her.

For you Anti-RH doctors out there, I don’t understand why you still can’t agree to pass the RH bill, with all that you’ve seen since medical school and clerkship. I bet almost everyone of you has rotated in government hospitals. You have seen the numerous poor pregnant women who have come in and out of these hospitals. You have heard their stories, of how they wanted only few children, but were stuck with 10 or more because they cannot refuse a husband asking for sex. You must have heard how most of these women would say they cannot complete their prenatal care because they’d rather spend on food and electricity than on transportation to hospital and medicines. You have seen how some of the health providers in these government hospitals have been rough and tough on these women, just so that they remember the pain and hardship enough to make them think twice before going into another pregnancy. You have seen the scope of how access to reproductive health medicines and procedures are sorely lacking in this country. How can you not agree with the passage of the bill? Because of your alma mater? Because of your religious convictions? This is not an issue of religion; this is a secular issue. Let these women have their choice!

3) Reproductive health education for the adolescents
The clergy keeps on asking, “do you want your children as young as 5 years old to learn about sex?” My answer to this is YES. Whether parents would be honest to themselves or not, one cannot deny the curiosity of a growing child. Yes, even at the young age of 5, kids do already have some questions related to gender and sex. As the kids grow older, the questions grow more mature and complicated. And it is the responsibility of parents to address these questions. But not every parent can be comfortable discussing sex with their children. Come on, be honest with yourselves. Have you ever discussed sex at any length with your mother/father? The all-too-common scenario at home is this: parent and youngster watching a movie on TV, then a kissing scene comes up. Father/mother brings up one hand to cover youngster’s eyes until the scene ended. “Don’t look, you’re too young for this!” And the youngster is either left bewildered at why he shouldn’t see those scenes or he already knows what those scenes are because he already saw movie at a friend’s house. Most Filipino parents would be just content at “screening out” the topic of sex without ever venturing into trying to give the appropriate knowledge to their kids. And unfortunately, these kids would learn about sex and reproduction through friends only. Talk about the blind leading the blind. And it is at this point that the whole barrage of misinformation and myths start and sometimes will culminate into teen pregnancy or other complications regarding relationship with another person.

And here comes the clergy telling us that only the parents should teach their kids about sex.

In the amended reproductive health bill:

SEC. 16. Mandatory Age-Appropriate Reproductive Health and Sexuality Education
Age-appropriate Reproductive Health and Sexuality Education shall be taught by adequately trained teachers in formal and non-formal educational system starting from Grade Five up to Fourth Year High School using life skills and other approaches… 

…Parents shall exercise the option of not allowing their minor children to attend classes pertaining to Reproductive Health and Sexuality Education.

I’m not sure where the clergy got the idea that the kids will be forced to attend sex education classes. It is rather clear that the parents have the option to let their children attend these classes. However, in my opinion, children as young as those in the 5th grade should have these classes already. Fifth graders are usually in the age of 11-12 years old and this age is the start of puberty. With many changes in their bodies, these children should be enlightened and armed with knowledge they need to understand these changes.

There is still plenty left to be discussed regarding the reproductive health bill, now that the clergy and their loyal followers are so hell-bent on obstructing the passage of this bill into law. This has also brought out the worst in some people, even if they think they mean well and are only fighting for what they think is right. However, what we must remember that reproductive health bill shouldn’t even be an issue anymore. Every country needs a good reproductive health care available to its citizens. We have our own personal beliefs regarding it, whether it be religious or not. But reproductive health is a secular issue and citizens must decide on this with the objective that the laws to be passed should be beneficial and appropriate to EVERYONE in the country.

Please see these related articles:

Complete Reproductive Health Bill Text http://rhbill.org/about/rh-bill-text/
Authors’ Amendments to HB 4244 http://rhbill.org/about/amendments-hb4244/

My older posts regarding the issue:
What the RCC hates in the Rh act http://prudencemd.com/?p=488
Family planning will be taught in classes in qc http://prudencemd.com/?p=428
Courting health disaster with Philippines’ anti-condom policies http://prudencemd.com/?p=396
The blog rounds: The State of Reproductive health in the Philippines http://prudencemd.com/?p=492

***Something I wrote a long, long time ago.  Just wanted to share this, considering that we’re in the “season of giving” nowadays.

Should I feel guilty because I bought and consumed this drink, which is worth P150, when I could have just given a part of that amount to the poor kid asking for alms on the street? Should I feel guilty that I have the time to spare to drink such expensive drinks when those who’re not so fortunate, have to work to the bone to find something to eat?

I think ads for charity are all too good eliciting that guilt feelings from us, so that we would donate to their foundations or fund-raising events. Of course, there’s nothing wrong with giving to the needy, but if we’re going to eradicate poverty, we should begin with eradicating the mentality of dependence.

And for such a reason, I prefer to give alms to street kids who’re selling flowers, or candies, buying their merchandise and giving an extra tip if they’re courteous than to those who beat at the car window asking for some coins. I prefer that those who’re asking for loans from me to do something reasonable for me in exchange of the money instead. That’s why I don’t want to write out a medical certificate letting an employee have a sick leave more than what should be so that he could have more pay for less work.

As a matter of fact, I’ve never believed in equal distribution of wealth. I find it a devolution of our value of giving rewards based on merit, shifting to a value of giving rewards based on need. I think what we should be propagating is a mindset that one should not get more because he needs more or that he has less than others, but rather, he will get what is due to him because of what work he had done.

But what about the poor? How can they get out of poverty if we will not help? I think in this part, we would all be better off we’re to concentrate on generating more jobs that are parallel to one’s available skills and how one is willing to work to achieve something, instead of using up resources for short-term solutions.

I remembered two guys I had as patients for preemployment medical evaluation. Both of them did not pass the first medical evaluation because of hypertension. The company who wanted to hire them requires that they first have a stable BP before being employed. I informed them about this and the two had different reactions. Patient A was mad that he isn’t qualified for employment. At first, he asked me to write him a favorable medical record so that the company will hire him at the soonest possible time. When I said I will not do that and suggested that he first undergo the treatment regimen that I will give him, he got angrier, did not even bother to listen to the treatment regimen, and told me how he could undergo such treatment if he doesn’t have a salary, that if perhaps I should give him the treatment free for 2 weeks, he might just be able to do it. He even said that perhaps I might be wrong with my diagnosis because BP readings taken by someone who has a stall at the mall reports that his BP is normal. I got frustrated by this but I still remained firm that he has to undergo treatment. He did not come back to the clinic, saying he’ll look for another clinic who’ll make him pass a medical exam.

Patient B showed disappointment at first that he wouldn’t be hired soon. But when I explained to him what he needs to do (lifestyle modifications, medical treatment), he willingly accepted, and listened patiently to what I instructed him to do.I monitored his BP for 2 1/2 weeks, after which the monitoring record showed a stabilization of BP at acceptable level enough for the company to hire him. I haven’t heard from Patient A again.

For me, people who’re like Patient B, who’re willing to do what is necessary to accomplish his goals are those worth helping out. He did not demand for that job simply because he is jobless, but rather, he did what is needed to get that job. Both Patient A and B have the skills, but it’s the attitude that spelled the difference.

And I hope most people would be more like Patient B. These are the people who will not demand things just because they have less, but rather, will work to make themselves worthy of what it is that they ask. This is the kind of attitude that all of us should have and it is the attitude that will get us out of being one of the impoverished nations in the world.

“The essence of all slavery consists in taking the product of another’s labor by force. It is immaterial whether this force be founded upon ownership of the slave or ownership of the money that he must get to live.”
- Leo Nikolaevich Tolstoy

It was in March that I first wrote about the “irregularities” I experienced as a medical resident in training in the hospital.  Perusing the post, I feel that I’ve stated much of my views already on what is needed to be corrected in the system.  And in a way, a lot of events have already occurred since then.  Sadly, however, nothing much have changed.

A number of unaccomplished discharge summaries are still there.  It took several months of having to stay overtime just to finish writing and even asking help from other co-residents.  An agreement was made that the more senior residents can help the junior residents finish the number of charts, in time for the next Philhealth accreditation, provided that a certain amount of the junior residents’ salaries will be split among those who helped write the discharge summaries.  A large volume of the unaccomplished charts soon diminished and it was, for a time, fair and well, as the junior residents begin receiving again their monthly salaries.  However, because we still continue with our duties (everyday 8 hours or more in the hospital and 24 hours every 3 days), the charts began piling up again.  Some had to resort to “other means” just to finish writing the charts.  However, I do not have financial means to go that way.  So I remain buried in those unaccomplished charts, and currently, without salary. My ATM card (the one used to receive salary from the hospital) was blocked and they did not even consider that I STILL HAVE THE REST OF MY MEAGER SALARY OF THE PREVIOUS MONTHS IN IT THAT I HAVEN’T WITHDRAWN AND OF WHICH I’VE ALREADY RIGHTFULLY RECEIVED.  And the 13th month pay, which is not actually a salary, but a bonus, IS ALSO PUT ON HOLD.   The condition, of course, for being able to get back all these “benefits” is that I should finish all said charts.

But what is it again that I’ve read in the Labor Code?

In Presidential decree no. 851, Section 10:

Sec. 10. Prohibition against reduction or elimination of benefits. – Nothing herein shall be construed to authorize any employer to eliminate, or diminish in any way, supplements, or other employee benefits or favorable practice being enjoyed by the employee at the time of promulgation of this issuance.

I’m certainly not a lawyer, however, I think that’s already a clear statement that the 13th month pay, for no reason, should be put on hold.  And to put this in perspective, the charts isn’t the summation of a medical residents work; it is only a menial part of it, done to provide the hospital the means to its insurance claims.  It would be fine by me, getting buried in all this chart work, if only we weren’t also burdened with the things that isn’t part of our job, like the job of interns.  Rumor has it that soon, we’ll be part-time medical technologists too, at the ER, because the hospital is planning to buy a laboratory equipment that enables one to run lab tests with results in minutes.  Okay, so the hospital is so much willing to shell out a few hundred thousand pesos for this one tiny machine, but isn’t willing to expand its laboratory staff and would rather put on the additional burden on medical residents (which is helped by the fact that we come in almost FREE of charge since we don’t get paid for work outside the job description)?

Do I really need to emphasize the reason for undergoing specialty training?  IT IS BECAUSE WE WANT TO LEARN A SPECIALTY, NOT END UP DOING EVERYBODY ELSE’S JOBS BECAUSE THE HOSPITAL DOESN’T WANT TO PAY FOR THEM.

However, I think the strongest argument by the hospital, so far, is that residents-in-training are just trainees, not employees.  In section 15 of Rule X of Conditions of Employment, it was said:

SECTION 15. Resident physicians in training. — There is employer-employee relationship between resident physicians and the training hospital unless:
(1) There is a training agreement between them; and
(2) The training program is duly accredited or approved by the appropriate government agency.

And thus, as the medical director said, “you are just trainees (insert sarcasm here).”

I think there is much confusion still as to the right status of resident physicians in training and this should be resolved soon.  It affects much the way the training hospitals treat their resident physicians.  The work is almost 24/7 and it’s more than definite that the absence of resident physicians in such training hospitals would greatly affect the hospital business.  Who would attend to patients in critical condition in the ward or at the ER?  A house or ER officer?  The hospital do not even want to pay the salaries of residents.  What more of an ER consultant?  Who can update consultants regarding the status of their patients in the ward?   And yet, we, residents, are considered “just trainees”?

However, as I’ve said in the first part of this Hospital Slave series (yes, I think this is going to be a series), nobody has raised this issue in the proper forum.  Although Batanes Representative Dr. Carlo Diasnes has authored a house bill aimed at managing medical residency in the country (HB 05222 or Medical Residency Act of 2008), it is still pending at Committee of Health since October 2008 and nothing has been heard of it since.

Is this because the current system of enslaving the younger doctors in training more beneficial to health care?  Is this a rampant practice or just limited to several hospitals?  Are they forgetting that we’re already LICENSED medical doctors?  Licensed professionals?

So, for now, stop wondering why some doctors would choose to shift to a different career, health-related or not.  It’s not selfishness; it’s a means to survival.

“Let me tell you why you’re here. You’re here because you know something. What you know you can’t explain, but you feel it. You’ve felt it your entire life, that there’s something wrong with the world. You don’t know what it is, but it’s there, like a splinter in your mind, driving you mad.”

- Morpheus, The Matrix

In as much as I believe that the topic of faith should not be shielded from the crucible of human reason, I’ve intently avoided talking or arguing about faith or the lack of it, except with a few trusted friends. From experience, I know it only ignites a series of heated arguments that almost always leads to exchange of below-the-belt comments and holier-than-thou/superiority-inferiority attitudes. I suspect that if the participants of such debates will not agree to certain basic rules before it started, the discussion will go nowhere. I mean, how could a person who believes a holy book contains the truth (and nothing but the truth) use the bible to argue his case if the other person he’s debating with, who believes in logic and evidence, do not believe that it is credible source of evidence?

And so, imagine my surprise when, one day, a colleague whom I know to be a member of Iglesia ni Cristo asked me one day if I know Richard Dawkins.

I said I’ve read Richard Dawkins’ work, The God Delusion. At the same time, in my head, my thoughts were circling around the possible direction where the conversation was headed to. I know how some INC members could cling hard on their faith and would not suffer anyone questioning their beliefs. I’ve quietly debated within myself, if I’m going to strike fast and hard, or just let go.

I guess he wasn’t quite aware of that brief, inner turmoil going in within me because he kept on asking about Dawkins’ works, “The God Delusion”, and other atheist writers. I told him briefly about “The End of Faith: Religion, Terror, and the Future of Reason” and “Letter To A Christian Nation” by Sam Harris, “God is Not Great: How Religion Poisons Everything” by Christopher Hitchens, and “Atlas Shrugged” by Ayn Rand in any decent bookstore. Or I could lend it to him.

He ranted on how he have these “dangerous” ideas that he had been cradling for a very long time. He was brought up believing the principles of INC, because his parents are members of INC. But for a long while he had some questions on what he supposedly strongly believes in and the questions continue to grow and multiply as time passes.

Then he went on to ask what my religion is.

I’ve to admit it took me a moment to answer. “I’m a baptized Catholic,” I replied, after what seemed to be a long intake of breath.

“Ah, I see,” he said. “But what are your inclinations now?”

I think that was the moment when I’ve to decide to call myself something.

“I’m a Doubter,” I told him.

“I think I am, too”, he said. “A Doubter with many, many, many questions.”

“Well, then, don’t be afraid of those questions.” I promised him that next time we see each other, I’ll lend him my books. In a sense, he reminded me of myself before. Those questions, I thought, plagued me. But in time, and after much contemplation with open eyes and mind, I saw that it wasn’t a plague. Rather, it’s as basic as the fuel we feed our brains, if I accepted that what could be mundane can also be awesome and inspiring. I think that stage of doubt and thirst for knowledge was described beautifully by Morpheus, in the film, The Matrix.

He hasn’t returned the book up to now.  But I hope he finds what he’s looking for in the book. Or even if not, at least, it can help him to free his mind.