Yet if one were to compare health’s share of the budget for this year and what the corresponding figure could be in the next, the difference isn’t much.

For 2010, the health allocation is 1.8 percent of the P1.54-trillion national purse. For 2011, the Aquino administration is proposing P32.62 billion for health –as indicated in the proposed National Expenditure Program — which is 1.9 percent of the P1.64-trillion national budget. The increase in terms of share in the total budget then would amount to just a tenth of a percentage point.

But that isn’t all. When he was still on the presidential campaign trail, Aquino had promised that health would take a five-percent share of the national budget. It would seem now that he is off by at least 3.1 percentage points from what he had pledged, and short by almost P50 billion in peso terms.

Aquino, however, appears to have an ally in Dr. Esperanza Cabral, who was the last secretary of the Department of Health (DOH) in the previous administration.

According to Cabral, the promised increase should not all happen in one year. “Because if you throw P80 billion to the department, but the department is not ready to spend it, sayang naman (it would just be a waste),” she says. The increase, she says, should be incremental according to the “absorptive capacity” of the DOH.

“The spending should be programmed because the accomplishments are also programmed,” Cabral says. “Hindi naman matatapos lahat ng health care problems natin sa isang taon (Our health care problems won’t be solved in just one year anyway).”

That’s putting it mildly. As it is, the Philippines is already unlikely to attain the Millennium Development Goal (MDG) No. 5 by the 2015 deadline – to reduce by three-fourths the number of mothers dying from child-birth complications, and to assure greater access to contraceptives.

Feeble, infirm

The National Economic and Development Authority (NEDA), which put together the latest Philippine Progress Report on the MDGs that will be out this week, does say that the country may have a medium to high probability of meeting other health-related MDG targets. But development and health experts would probably agree that “feeble and infirm” are apt descriptions for the delivery of health services in this country, especially to the poor.

And yet the Aquino administration is poised to maintain several key health programs of its predecessor, even though these had been plagued by inefficiency and political interference, among other things. These include health subsidies under the conditional cash transfer program and Philhealth’s sponsored program, which is co-financed by national and local government agencies.

One major point of divergence it has with the previous government regarding public health, though, is in the area of reproductive health.

Aquino had some quarters worried that he was about to renege on another campaign promise when he reportedly said he needed to review the reproductive health bill and rename it the “responsible parenthood bill.”

But statements made just last week by Health Secretary Enrique Ona assured most of the Aquino government’s support for artificial contraceptives, which would be among the range of choices to be offered to couples.

The support would include funds for the availability of contraceptives in government health centers. Ona also said that the government would support sex education, which had been strongly opposed by the local Roman Catholic Church hierarchy and lay groups.

Arroyo’s failure

Aquino’s immediate predecessor, Gloria Macapagal Arroyo, was known to frown on government programs that incorporated artificial contraceptives, including initiatives promoting maternal health, as well as those aimed at preventing HIV/AIDS or the human immunodeficiency virus and acquired immune deficiency syndrome.

In large part, say development and health experts – and even Cabral – this is why the Philippines will be unable to achieve MDG No. 5.

In 1990, the Philippine maternal mortality rate (the number of women dying from pregnancy or childbirth-related complications for every 100,000 live births) stood at 290. This figure was supposed to be reduced to 52 by 2015.

But the current maternal mortality rate is 162, which translates to about 12 women dying each day while giving birth.

Most of these women are poor. After all, according to the 2008 National Demographic and Health Survey (NDHS), a woman in the lowest wealth quintile will bear an average of 5.2 children in her lifetime, compared to an average of 1.9 children for a woman in the highest wealth quintile.

In general, this is because the poor have less access to more family planning methods, even though they may want to space or limit their childbearing.

Income divide

For sure, proper medical attention and hygienic conditions during delivery are crucial in lowering the risks of women dying during childbirth. But in this area, there appears to be a huge divide between rich and poor women, between the educated and uneducated, and between urban and rural residents, says the United Nations Population Fund (UNFPA).

In the National Capital Region (NCR), for instance, almost nine in 10 deliveries are attended by skilled health professionals, versus only two out of 10 in the Autonomous Region in Muslim Mindanao (ARMM), 2008 NDHS data show.

Indeed, the fact that she lives in Metro Manila may be why Claire Briones has yet to encounter any real problem while giving birth. Still, she says she dreads having any other medical emergency. At 35, Briones has four children; she is a single parent.

In theory, Briones’s family may qualify as one of the beneficiaries of the Conditional Cash Transfer (CCT) scheme that was the flagship anti-poverty program of the Arroyo administration and which is being continued by Aquino.

Known previously as the ‘4Ps’ or the ‘Pantawid Pamilyang Pilipino Program,’ the CCT’s health component includes maternal health care for pregnant women, responsible parenthood seminars, and regular health check-ups and vaccinations for children below five years old.

But because the program is built on providing cash subsidies to indigent families, the question of sustainability has been raised against it.

Target: 4.7M families

For this year, the scheme’s target coverage is one million families. That translates to a monthly funding requirement of P500 million in health subsidies alone. Aquino, however, plans to expand coverage to all poor families – a figure that reached 4.7 million at last count. CCT health subsidies would thus come to about P2.35 billion a month.

The specter of ever-rising subsidies becomes all the more acute given the program’s apparent lack of any timeline (save for the maximum of five years that each beneficiary family can avail itself of the scheme’s benefits).

Interior and Local Government Secretary Jesse Robredo says that the CCT program had improved “health and education outcomes” in Naga City when he was mayor there. But he says that subsidies provided to the poor should be time-bound. “If not,” he says, “then (the program) is clearly not working.”

Briones does not seem to have heard of the CCT. But she says she was once a member of Philhealth, the national health insurance program that began in 1995.

Aquino has promised Philhealth coverage for all Filipinos within three years. He may not have to do all that much to achieve that if one were to go by Philhealth’s claim of having 85 percent of the population as its members. Yet even assuming that Philhealth’s figure is accurate, ensuring universal access to health care is obviously more than handing out Philhealth cards.

Even current Philhealth members think twice before seeking treatment, considering that the insurance covers only a small portion of the fees in accredited facilities – about 20 to 35 percent, according to Cabral.

Leverage, palakasan

Briones says that even when she was still a Philhealth member, she would bring her children to the barangay health center instead of a Philhealth-affiliated facility. With the earnings of her tiny neighborhood sari-sari store barely enough to feed all her children and keep them clothed and clean, Briones simply has no budget for medical expenses. She says she was able to use her Philhealth card just once, when she gave birth to her youngest child two years ago.

Briones was actually a beneficiary of Philhealth’s indigent program, in which a local government splits the premium payments with the national government. According to Philhealth’s 2010 first quarter report, the indigent program has 4.98 million beneficiaries or about 25 percent of the entire Philhealth membership.

But even Cabral concedes that the program has been used for less than altruistic purposes. “Local government officials will actually use this as leverage for political favors, for votes, etcetera,” she says.

Briones herself says that she would not have gotten a Philhealth card had she not known the barangay coordinator assigned to her neighborhood. And now that the coordinator had passed away, Briones says she has been unable to renew her membership. She says the new coordinator lives elsewhere and tends to favor her own neighbors.

“Palakasan kasi (It depends on who you know),” Briones says.

Last year, NEDA also reported in its Updated Medium-Term Philippine Development Plan 2004-2010 that Philhealth’s sponsored program has been largely dependent on “the willingness of (local governments) to enroll their constituents.”

NEDA Social Development Staff assistant director Cleofe Pastrana says as well that in the past, many local governments were unable to sustain their part of the premium payments for Philhealth’s indigent program.

“That’s why the money at (the budget department) cannot move,” says Pastrana, “because without the (local government) counterpart, the money for health insurance wouldn’t be provided.”

The recalcitrance – and sometimes sheer unwillingness – of local governments to support national health programs or follow suggestions by the health department has left the likes of Cabral exasperated.

Devolve health service?

The way Cabral sees it, the most important reform that the health system needs is in the area of devolution. “We need to make up our minds whether the devolution of health services is good or not,” she says.

To which Robredo retorts: “It’s not a question of devolution, it’s getting the right people for (the task).”

He admits, however, that local governments seem to be out of the loop regarding national health priorities. He cites the case of the MDGs, among which the health-related ones focus on prevention.

“It’s not sexy at the local level,” says Robredo of the MDG thrust. “The issue there is ‘how many have I provided health assistance to’.”

But he argues that local governments would be encouraged to prioritize MDG-related programs if achieving the targets resulted in tangible rewards for the towns and cities, such as more funds.

Yet additional monies may not be enough to encourage local government executives to, say, allocate the necessary budget to keep their health centers stocked with contraceptives. That would, after all, mean, going head to head with religious leaders who wield great influence especially over rural communities.

Wanted: Direction

In 2004, then Health Secretary Manuel Dayrit issued Administrative Order 158 or the Contraceptive Reliance Strategy that gave local governments the task of providing contraceptives to their constituents – either for free or at cost.

The strategy’s failure can be seen in the lack of free contraceptives in public health facilities, which NEDA’s Pastrana says caused the very slow progress in contraceptive use rate. In 2003, the rate was 49 percent. Today the comparative figure is 51 percent – quite a long way still from the MDG target of 80 percent.

Some observers are optimistic that with the Aquino administration’s stance on reproductive health, local governments may give AO 158 a chance.

But there are those like Donato Macasaet, executive director of CODE NGO or the Caucus of Development NGO Networks, who say they would be surprised if Aquino would be able to achieve the health targets – particularly the one on maternal health – that the Arroyo administration had missed miserably.

Macasaet, though, says that he would be content if the Aquino government provides even just the direction so that the MDGs would be attained “if not in 2015, at least soon after.” – PCIJ, September 2010

In the course of our conversation, the barangay captain of San Andres also kept telling us that her people will not leave this village unless they are paid proper compensation by San Miguel.

Then it hit us. Kapitana Sofia, we said, we are not from San Miguel. Media po kami.

Ay, akala ko San Miguel kayo, she apologized, and the room seemed to brighten just a little bit more.

The kapitana’s apparent hostility toward a name we normally associate with malted barley and hops and happy hour stems from the fact that San Miguel Bulk Water Company, a subsidiary of food-beverage giant San Miguel Corporation, has submitted an unsolicited bid to undertake a joint-venture project with the Metropolitan Waterworks Sewerage System (MWSS) to build the Laiban dam here in Tanay, Rizal.

The Arroyo government recently revived plans to build the 113 meter-high dam at the fork where the Limutan and Lenatin rivers merge into the Kaliwa River, which then merges with the Kanan River before roaring off to the Pacific. That means that after almost three decades of having their fates on hold, residents of San Andres and seven other barangays in Tanay and Quezon are again faced with the prospect of eviction.

The dam was conceptualized in the late ’70s to provide Metro Manila with an additional 1.9 billion liters of water a day and generate some 25 megawatts of electricity. But according to opponents of the dam project, some 10,000 residents will be displaced when the proposed dam submerges the barangays of Laiban, San Andres, Sto. Nino, Sta. Ines, Mamuyao, Tinucan, and Cayabo in Tanay, and Barangay Limutan in Quezon.

Many of these residents are members of the indigenous Dumagat and Remontado, who consider this watershed as part of their ancestral lands and have lived in these parts for centuries. In fact, the kapitana herself is half Remontado, but that may not keep her safe from eviction. According to the kapitana, village chiefs of the affected barangays have already been meeting with representatives of San Miguel Bulk Water.

Last week, the Philippine Center for Investigative Journalism revealed how unusual secrecy and haste mark the MWSS’s tender for the P52-billion project.

Rival bidders were given only five days to submit counter-offers to San Miguel Bulk Water’s bid. But San Miguel already seems so unusually far ahead in the race to win the dam bid.

It is not clear how far the talks with officials of affected barangays have progressed. At the same time, even before any potential rival in the bid could buy bid documents, San Miguel also seems to have been already dealing directly with the residents.

A staffmember of a division of San Miguel Bulk Water confirmed this to PCIJ recently. The staffer, who asked not to be named, said that representatives from the company have been engaged in talks with the affected residents this year. In fact, the staffer said, the talks may have begun as early as last year. The staffer, however, refused to reveal what was on the table for discussion or how far the talks have gone.

The MWSS, meanwhile, has taken a more low-key role. The kapitana said that MWSS representatives are afraid to come to their barangays for fear that angry residents would take things into their own hands.

And coming to these remote barangays is no easy feat – not for visitors, not even for residents. To get to the more accessible barangays like San Andres, one has to drive down steep, slippery roads that probably disappear with the first hint of rain. The community sprawls out from the barangay center, marked by a large multipurpose hall and an elementary school building. The rest of the structures in the barangay look like they just grew out of the ground.

And that’s San Andres, the barangay that’s easy to reach. The most populated barangay is Laiban, with at least 2,000 residents. To reach it, one has to ride a monster jeepney that crams people inside and on the roof, before lumbering gingerly down a slide of a mountainside and navigating through rivers and creeks like a water buffalo.

That one monster jeepney plies the route to the Tanay town proper only three times a week. The rest of the week one is stuck in or out of Laiban. It’s that kind of a barangay.

Opposition to the dam has apparently been pretty effective, at least up to this point. After almost three decades in the making, the dam project has left behind a trail of false starts. A set of massive water diversion tunnels has already been built from Barangay Laiban to nearby Barangay Daraitan. Also, some of the original residents have already been given compensation in the 1980s, according to Tanay Development Officer Adorable Sunga.

The problem, Sunga said, is that when the project was shelved, many of those who accepted the money did not leave the area, and instead grew deeper roots and created even larger families. Also, new families have settled in the watershed area in the last 30 years or so. The government expected to resettle 4,000 people in the 1980s; today, that figure has climbed to 10,000, all of whom now have to be paid and resettled.

The kapitana admitted that many residents had already been paid, some with 40 percent, others with 100 percent. No one seems to know just how much money people here were given by previous administrations. But the kapitana said this project with San Miguel will be a new deal altogether, with a new generation of claimants to consider. She didn’t say exactly how much the residents are asking in total, but said that the figure would run up to the billions.

Compensation certainly appears to be a prime concern in this barangay, at least among the local barangay officials. The kapitana said the village chiefs have already passed a resolution pegging compensation for displaced families at P3 million to P5 million each.

Village officials have also been rather loudly asking that they be given additional money by the project proponents for their troubles in reaching out and informing people about the revived dam project. Making like a walking calculator, the kapitana said that perhaps another P200,000 per barangay would do.

But then she mentioned that there are residents, especially the older ones, who would rather be buried here than be moved out. Ancestral roots are deep, and while some roots can be dug out for the right amount, other roots would rather die in place.

Curiously, part of the reason why the watershed area is so undeveloped may also have to do with the fact that the project has been perpetually in suspended animation.

Sunga noted that the dam project has hung over these eight barangays like a sword of Damocles for close to two generations. Since local businessmen and politicians know that these barangays may end up going underwater if government insists on pushing the dam project, no one is willing to pour much money into developing these areas. Schools built for children may just end up being inhabited by schools of fish.

The kapitana herself said that she was only 12 years old when residents of San Andres were told they were being moved out to make way for the dam. There was a lot of bitterness at that time among the local residents and the tribes, but it was bitterness tempered by the reality that the government would get its way in the end.

Now 42, the kapitana said that she would have no problem moving out, even though her father is a Remontado; she has another house in the upper portions of Tanay, where she can resettle.

But resettlement for the thousands of other residents may be a big headache that no one has yet factored into the equation.

When the project was conceived in the late ‘70s, the government went as far as to identify a resettlement site in San Ysiro, Antipolo. Sunga, however, pointed out that it’s been so long since the project was conceived that the resettlement site for the Laiban Dam evacuees has already been filled up with people from other communities.

In other words, the dam has a ready home, but the people it will displace do not. – PCIJ, July 2009

It has been almost a year since fighting broke out between government forces and the Moro Islamic Liberation Front after the Supreme Court struck down the Memorandum Agreement on Ancestral Domain. While the story of the continued fighting still makes headlines, the story of the refugees who fled the fighting has been dropped from the frontpages and the line-ups of the major newscasts. Recently, a group of journalists travelled to Mindanao to chronicle the plight of the refugees and to remind the public of the people they have so easily forgotten. Photos and narration by Nonoy Espina.

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  An absolute privilege

VALLEHERMOSO, CARMEN, BOHOL — Had she been in the same situation eight years ago, Jesusa Panes would have probably just given birth at home, even without her husband in sight, and even if her neighbor the hilot (traditional birthing attendant) happened to be drunk. But things have not been the same for expectant mothers in this town since 2002, and so when the child in her belly starting demanding to be let out, Panes began trudging toward the birthing center that was several minutes away by foot from her home.

The drunken hilot did his duty by swaggering behind her, seeing to it that she got to the center safely. Carmen is in fact the only town in Bohol that has legislated that all mothers must give birth at designated birthing facilities in five barangays or at the town’s birthing center (rural health unit or RHU), a P2.5-million, sprawling facility that offers first-class service for very low fees. Carmen’s laws also say a hilot should bring laboring mothers to the nearest birthing clinic to ensure a comfortable and safe delivery. And even if a hilot is trained, he or she cannot aid in a delivery, unless a midwife sits nearby to oversee the process.

	THESE days, mothers like Lilia Angcog can give birth for only P500. [photo by Avie Olarte]

The result of such legislation has been practically no maternal death in Carmen’s 29 barangays in the last five years, save for one in 2006. According to Dr. Josephine Jabonillo, Carmen’s municipal health officer (MHO), that unfortunate mother-to-be tried to deliver at home, with her father-in-law as the hilot. The father-in-law turned out to be untrained; the woman hemorrhaged to death.

“Most maternal deaths can be prevented,” says Jabonillo, an obstetrician/gynecologist. “Mothers all over the world die due to the same major complications of pregnancy: hemorrhage, hypertension, sepsis, and unsafe abortion.”

Globally, women continue to die due to complications of pregnancy and childbirth at a rate of one per minute. The limited progress in making motherhood safer is more alarming in developing countries, where 99 percent of maternal deaths occur every year. Here in the Philippines, about 10 to 12 women die every day due to pregnancy-related causes. The government has even admitted that it may not meet its commitment to achieve Millennium Development Goal (MDG) Number 5 — to drastically reduce the number of maternal deaths — by 2015.

And yet here is this town of 41,519 people that has been demonstrating just how far better local governments can be at keeping mothers healthy. Aside from its innovative laws regarding maternal health, Carmen also has what it calls the Enhanced Safe Motherhood Program (E-SM), which not only pushes for a RHU-based delivery, but also includes a pre-natal assessment, monthly check-ups, access to medicines, and other maternal health services — all for a nominal fee.

Location map of Carmen, Bohol courtesy of Wikipedia

TO FULLY appreciate what Carmen has accomplished so far, consider this: as late as 2005, the proportion of births attended by skilled health workers nationwide stood at 63.7 percent. In 2006, meanwhile, the national maternal mortality rate — the number of deaths per 100,000 live births — was 162. To be considered as having met MDG No. 5, the Philippines has to have all births attended by skilled health workers by 2015, as well as have reduced the maternal mortality rate to 52.3.

This predominantly agricultural town with more than half of its people living under the poverty line has managed to best those numbers — and how.

Yet even up close, there seems to be nothing that can make Carmen stand out among other rural towns across the Philippines. There are the small town center that passes for its urban area and a collection of dusty barangays. There are some cars and jeepneys and a lot of motorcycles. And just like any other Philippine town, there are children — lots of them — scampering about in the streets.

Then again, there is that birthing center, a 10-bedroom facility that is complete with delivery tables and laboratory equipment and can top the services of any hospital in this province some 800 kms south of Manila. Completed in 2006, it won a Sentrong Sigla Award (Center for Vitality) the very next year. According to the Department of Health (DOH), it is one the best rural health units in the country.

Building a good facility was on top of Jabonillo’s list when she became the town’s health officer in 2002. But she says it was no easy task, recalling that she had to first lobby hard with the local government officials.

“Carmen at the time had a very high record of maternal death,” Jabonillo recounts, “So I told the mayor we had to address it.”

Although the E-SM was Jabonillo’s idea, the local health board (headed by the mayor, and with Jabonillo, a councilor, and a nongovernmental organization representative as members) helped craft the program.

For the past five years, Carmen has had no maternal deaths except for one in 2006. Credit that to its award-winning rural health unit, which is complete with bedrooms, delivery tables, and laboratory facilities. [photo by Avie Olarte]

Jabonillo says that the town records revealed that the maternal deaths in Carmen were often caused by unhygienic and improper birth delivery practices. She also noted that there were also few skilled birth attendants, while women barely had access to pre-assessed normal delivery from the provincial hospitals.

These days, aside from the main one in the town center, five of Carmen’s barangays have birthing facilities. There are no doctors in these centers, but a midwife is usually on call, along with an army of barangay health workers; should any complications arise, an ambulance (Carmen has six) can be dispatched to bring the pregnant woman to the RHU.

But convincing the women to try the services of these clinics proved difficult. For one, the women thought they would be charged high rates. For another, they were simply more used to the hilot, some of whom even discouraged the pregnant women from going to the RHU. (This is, after all, a country where half of births still occur at home, and a third assisted by hilots. In Bohol, 17 percent of all the births in 2006 were aided by trained and untrained hilots, most or 53 percent are assisted by midwives.)

On E-SM’s first year, the RHU had a total of only eight deliveries. But by 2006, which was also the year the council passed the ordinance banning trained hilot from delivering babies, about 400 women ended up giving birth in the town facility.

“Maternal and birth complications were reduced to 50 percent,” Jabonillo says, leading to Carmen’s near-zero maternal death record.

AT VALLEHERMOSO, one of the barangays with a birthing center, the barangay midwife keeps track of all the pregnancies in the area. The health unit has on its white wall a pregnancy watch board that lists the names of pregnant women, together with the estimated date of confinement, last menstrual period, place and (estimated) date of delivery. There are also free pre-natal check-ups and some medicines, like iron tablets (many of Carmen’s women are anemic), are free as well.

Lilia Ancog’s barangay has no birthing center yet, so when time came for her to deliver her third child, she went to the main birthing center in town. Even then, she says her total bill came to only P500, or about 25 percent of the cost of a hospital-based delivery. She says that with her two older children, she had paid double that amount, and those deliveries were even done at home through a midwife.

“(It’s) high quality obstetric services at very reasonable amount,” says Jabonillo, who does not charge a doctor’s fee for the deliveries she does.

The doctor says that all the birthing center’s proceeds go to buying medicine and supplies like gloves and cotton, on top of the P1-million worth of drugs that the local government allocates for the RHU every year.

A patient in Carmen can even end up not paying anything at all. Last September, Carmen came up with a program for indigents with the government-run Philippine Health Insurance Corp. Through the program, a patient can avail of the Maternity Care Package that covers the first three deliveries, newborn screening, laboratory works, accommodation, medicine, and the P500 user’s fee.

VALLEHERMOSO remains one of the most densely populated barangays in Carmen. More than half of its population live below the poverty line. [photo by Avie Olarte]

That’s not all: Carmen is also one of only three towns in Bohol that have adopted a Reproductive Health Care Code; Bohol province itself has yet to pass one.

Carmen’s code mandates, among others, that women must have access to safe and quality reproductive healthcare services and that there should be a continuous planning, implementation, and monitoring of effective reproductive-health programs.

The code also ensures a steady stream of funding for reproductive health services, on top of the P50,000 allocated for the reproductive health advocacy program. A look at the town’s spending pattern shows that it allots an average of nine percent every year for health services compared to an average of four percent for infrastructure. (In most towns in Bohol, as in many local governments, building roads and bridges is prioritized over health and social services.)

For sure, though, the code has its critics. Some church workers have called its proponents “devils” and even launched a radio program to discredit the local officials pushing for it. One official who suffered such a backlash is Nathaniel Binlod, a two-term town councilor and chairperson of the town’s health committee. He almost lost in the 2007 elections, he says, for openly advocating and raising awareness on reproductive health and population management.

“I’m not for abortion,” says Binlod, who was born and raised in Carmen. “What I’m campaigning for is responsible parenthood. Two to three children are enough.” (The average family size in Carmen at present is 5.3.)

ACCESS TO reproductive-health services in Carmen comes in the form of making contraceptives available to the public. Together with the United Nations Population Fund (UNFPA) — with which it has partnered for such things as the ambulances and setting up barangay birthing centers — the town has built a Pop Shop that sells condom and pills at lower prices than those at retail stores.

HEALTH workers keep track of the condition of pregnant women in Vallehermoso. [photo by Avie Olarte]

The RHU itself allots P50,000 to P75,000 a year for buying contraceptives alone. The award-winning facility even has a Family Planning Room where couples can consult with a doctor regarding which family planning method would be best for them.

More Pop Shops are already being put up in the barangays. But women like Beatriz Manda, a 44-year-old mother from Vallehermoso, are unlikely to step foot into one unless they visit a local health unit first.

Manda says the natural way doesn’t work for her and her husband, because she has irregular periods. They already have 11 children, with the youngest only five months old.

But it may take some doing before she and her husband consider artificial family planning methods. “I’m afraid of the IUD (intrauterine device),” says Manda. “My husband meanwhile doesn’t like the condom, he says it might slip off.”

Someone also told her that once she has had a ligation, she wouldn’t be able to help her husband in the farm anymore.

Manda confesses that she has not paid a visit to the barangay’s midwife, who could help clarify common misconceptions on artificial family planning methods. But she says she is planning to go one of these days.

CONDOMS and birth-control pills can be bought for a cheaper price at Popshops. [photo by Avie Olarte]

If she opts to go to the RHU, she may just bump into Lilia Ancog, the mother who just gave birth there. Ancog is planning to visit the town doctor again as soon as she has had a few days of rest. She says she and her husband need a family-planning method aside from the natural way, which doesn’t seem to work for them. Her husband wants a fourth child, but Ancog says they can afford only three.

As for Jesusa Panes — the pregnant woman who with her drunken hilot walked all the way from her home to the barangay health center — she reached the place in one piece, the baby still safe in her tummy. And while she was sweating profusely when she arrived and was visibly worried that she would give birth any minute, she seemed to calm down somewhat after she downed a glass of spring water. As people fanned her, Panes politely declined offers to bring her to the nearest hospital, saying the midwife would take good care of her.

She later gave birth to a baby girl, her fourth child. Mother and newborn daughter are doing fine.

• I want my MDGs
• Whither the MDGs?
• Toilet trouble
• An island slakes its thirst
• Naga City’s class act
• A school board makeover
• Making sure Mama makes it
• No cure for costly medicines?
  Draft law affirms patient rights of drug firms
• Arroyo fails COA audit: Fairness of President’s books ‘doubtful’
• Gloria’s spending spree: Travel, ‘donations’ top Palace expenses
• First Person
  Still reeling from military junta, Burma a mess after cyclone
• Perspective
  An absolute privilege

NAGA CITY’S successes in its poverty alleviation efforts no doubt allowed it to focus its resources on improving access to basic services like education. But all its education reform efforts could not have been possible without its reinvention of the local school board.

The transformation began in 2001, when the MDGs were largely unheard of and a national government directive for the goals to be localized and included in development planning processes was yet forthcoming. But Naga’s decision then to revamp the school board’s orientation and organizational structure later put the city in a better position to address the gaps in achieving the MDG targets in education.

From a mere budgeting body of the Department of Education (DepEd), the Naga City School Board has since been empowered to make it more pro-active and responsive in the delivery of basic education. The school board’s organizational structure was also expanded to ensure quality multisectoral community representation.

Representatives from the academe, business, religious, alumni associations, and nongovernmental organizations now sit in a community advisory council. At present, the council is made up of the Metro Naga Chamber of Commerce president, the head of the Naga City People’s Council (NCPC), and the high school principals of the Ateneo de Naga University and University of Nueva Caceres.

In tacit recognition of this Naga innovation in public education, the National Economic and Development Authority (NEDA) regional office cited in its Bicol MDGs report the important role played by local school boards. To improve governance, resource allocation and utilization, NEDA pointed to the need to strengthen the role of school boards in overseeing quality of education in their localities and improving access to schools.

Jesse Robredo says his first three terms as mayor of Naga made him realize how “woefully underutilized” the school board was. This was because, he says, the Local Government Code continued to reflect the bias for a centralized public school system.

“For the last three decades, (this) has simply failed to work,” he says, pointing to the Code’s provisions on the local school board that “to my mind, reinforces this institutional ineffectiveness and worse, shackles progressive communities like Naga, Bulacan, Cebu, and Marikina.”

By tradition, the local government left the work of defining the education priorities to be funded by the Special Education Fund (SEF) to the DepEd’s Division of City Schools. Though the school board has eight members, often the decision-making rested on only two powerful members: the mayor as local chief executive and the division superintendent.

Because of the school board’s limited involvement, its budget, the SEF, also became susceptible to being spent on non-priorities, more often than not on corruption-prone infrastructure projects and regular sports events.

Naga City Planning Coordinator Wilfredo Prilles Jr. says the participatory development process has largely helped redefine the directions of the school board. For one, he says, the school-level and sectoral consultations brought to its attention the stakeholders’ “overwhelming preference for soft infrastructure” — in the form of textbooks, instructional materials, desks, and armchairs — over school buildings, as well as the need for staff development in terms of teacher training and performance-based incentives.

Prilles says that key to the school board’s empowerment is its strong body of stakeholders at the local level that helps in the preparation of the local education plan and budget, as well as in identifying alternative ways to finance the said plan. This, he says, has made policy decisions and resource allocations more attuned to the actual needs of the city’s 36,000 public-school children.

To replicate the school board advisory council, there are local governance councils now in place in each of the 29 elementary schools to more fully involve local communities in the management of the public school system.

But Prilles says that there is a lot more that needs to be done in this area, particularly in making the councils truly functional. “There’s still a tendency among school heads to control decision-making instead of sharing power with the council,” he says.

Still, Dr. Malu Barcillano, director of the Center for Local Governance at the Ateneo de Naga University, says that with its pioneering initiative to reinvent the local school board, Naga has crafted a “new education paradigm” that adopts a “broader view of the Local Government Code.” It does this, she says, by “applying a deeper understanding of the law, and shifting away from conventional wisdom and traditional practice.”

Barcillano, who did a case study of this particular Naga innovation, cites the project for local autonomy in the provision of quality public education through administrative and organizational reforms, guided by the principles of good governance that the city has been known for: participation, predictability, transparency, and empowerment.

“The proactive and responsive stance of the board is used as a vehicle to involve the local government officials and the entire community in owning the responsibility of ensuring that the children gain access to quality education,” she says. “It becomes a powerful tool which develops accountability of schools to the community. It reminds them that their responsibilities to the children and the youth are not only beneficial at present, but most importantly to the future generation.”

• I want my MDGs
• Whither the MDGs?
• Toilet trouble
• An island slakes its thirst
• Naga City’s class act
• A school board makeover
• Making sure Mama makes it
• No cure for costly medicines?
  Draft law affirms patient rights of drug firms
• Arroyo fails COA audit: Fairness of President’s books ‘doubtful’
• Gloria’s spending spree: Travel, ‘donations’ top Palace expenses
• First Person
  Still reeling from military junta, Burma a mess after cyclone
• Perspective
  An absolute privilege

KAHIKUKUK, BANGUIGUI, SULU — Asaali Muhalli is no ancient mariner, but there was a time when his lament was practically an echo of that of the protagonist in Samuel Taylor Coleridge’s famous poem: “Water, water everywhere, and not a drop to drink.”

Muhalli, a 40-something schoolteacher, has lived in this remote village since birth. He recalls, “I lived on an island surrounded by water, yet ironically, our life was without drinking water.”

But for the last two years, Muhalli and the rest of the residents here have had no reason to sigh — at least not over the lack of potable water. In September 2006, Kahikukuk became the beneficiary of a solar-powered system to supply drinkable water to the entire village, and life here has not been the same since. For one, says Muhalli, water-borne diseases are no longer as common as before. For another, villagers have stopped digging just about anywhere they could think of in their desperation to tap an underground water source.

Muhalli says that one of his neighbors began digging a hole in his own backyard, hoping to strike water. Instead, the neighbor unearthed a pile of human skeletons. According to Muhalli, his neighbor decided to transfer house posthaste.

Impoverished communities elsewhere in the country probably do not share Kahikukuk’s near-moonscape past, but many (if not all) of them can certainly sympathize with its former thirst for potable water. In fact, many areas in the Philippines still lack access to safe drinking water, which has led to a significant incidence of water-borne illnesses, among other things. Across the province of Sulu, of which this island is part, only 26.8 percent of families have safe water to drink, according to the 2002 Annual Poverty Indicators Survey (APIS); from all indications, that figure is not going to improve significantly anytime soon.

It’s no wonder then that the government itself has cautiously predicted that the country has a “medium” chance of achieving the target of halving the proportion of the Philippine population without sustainable access to safe drinking water by 2015. The target falls under the Millennium Development Goal (MDG) of Environment Sustainability that the Philippines is committed to meeting seven years from now. Numbering eight in all, the MDGs, which range from education to health, to food security, are part of a global initiative to combat poverty.

The initiative stresses the cooperation of aid agencies, national governments, and the private sector in the effort. Indeed, Kahikukuk may not have gotten its rather unique water system had such cooperation been absent. Banguingui Mayor Hadji Wahid Sahidulla himself says that with his local government’s meager budget, “we cannot afford to develop such a project, considering the many immediate needs (of) our constituents.”

LOCATED ABOUT five hours away from Zamboanga City by motorboat, Kahikukuk is part of the Tongkil group of islands in Sulu. It is home to some 30,000 Samal-Banguigui natives who depend largely on fishing and seaweed farming for their livelihood. Some families also operate motorboats that ferry people to nearby islands, but even then many households here often can afford to have only two meals per day.

Kahikukuk’s story illustrates how the lack of access to potable water can make an already poor community even more impoverished. Children suffering from water-borne illnesses like cholera and diarrhea, for example, lost days — sometimes weeks — of school, while similarly stricken adults were unable to work.

Muhalli says that as far as he knows, at least three children died in the village because of some disease that was later traced to unclean water. Banguigui Island Municipality health statistics also show diarrhea as among the top three causes of infant morbidity in the area.

A father of two boys, Muhalli adds that his family’s paltry household budget shrank even more each time they bought water that was brought in from neighboring Basilan. Peddlers sold each 20-gallon container for P25; normally, says Muhalli, one household would consume some 10 containers each day.

The alternative was to fetch water from either any of the makeshift deep wells that still dot the island or the main water source that was about an hour’s walk from the village. That source, a very deep open well located near the foot of a hill, is adjacent to a muddy area where cows like to wallow.

During the rainy season, the well would overflow and the surrounding field would be flooded. The result was water that was murky with soil and animal dung. But the water did not necessarily clear up whenever the sun was out.

“I could waste a whole day just to fill two containers and even then the water was brown,” says Ernilisa Jurail, a 28-year-old mother of four, recalling her long treks to fetch water for her family. “I also had nothing clean to wear. I washed my clothes and took a bath only once a week.”

The backyard wells were no better, perhaps because many families also maintained their latrines in the same area. Experts point out that even professionally built tube wells are easily contaminated when these are located less than 30 meters away from animal ditches, latrines, stagnant waters, garbage, and poor drainages.

Many of the families thus tried to save rainwater in huge drums and jars. But they had a hard time keeping this free from mosquito larvae, says Muhalli, and so they would try to filter the water through cloth and boil it before drinking it. He also recalls how some women and children would brave going to Abu Sayyaf-infested Basilan just to get potable water.

WHEN THE Alliance for Mindanao Off-grid Renewable Energy (AMORE) program reached Kahikukuk in 2003, however, the objective was to give the local community electricity. After all, AMORE, which has been energizing communities since 2002, was formulated to develop a sustainable approach to rural electrification.

AMORE is a joint effort of the U.S. Agency for International Development (USAID), Mirant Philippines Foundation, Inc., the Department of Energy, the Autonomous Region in Muslim Mindanao (ARMM), and the nonprofit group Winrock International. The program helps promote peace and progress in Mindanao by energizing poor, remote, conflict-affected communities that cannot be connected to the power grid with clean, indigenous, reliable, and affordable stand-alone renewable energy systems, such as solar and micro-hydropower.

But its proponents soon realized that installing renewable energy systems was just a development starting point. And so even before putting in the power systems, AMORE workers began identifying and organizing partners in the local community into Barangay Renewable Energy and Community Development Associations (BRECDAs). These associations were then trained not only to operate and maintain their renewable energy systems, but also to pursue other development projects for their communities.

AMORE had found Kahikukuk lit with gas lamps. Five years ago, it brought in solar photovoltaic battery-charging stations that were enough to light up about 30 homes. After further consultations with the villagers, AMORE’s proponents concluded that the island also needed to have a reliable and sustainable water system if they were really serious about improving lives here.

Three years after it had its first taste of electricity, Kahikukuk got the first solar-powered water system in the entire ARMM. The system consists of a confined well, a 0.75-horsepower submersible capacity pump driven by a 320-watt peak solar photovoltaic power cell, an elevated 8,000-liter reservoir, and a 1,000-meter pipeline that delivers the water to six tap stands.

The heart of the system is approximately 300 meters away from the village, but the taps are right in the community itself, sparing villagers a long walk for water.

The water pumping system requires no fuel deliveries and needs very little maintenance. Most importantly, a solar pump produces the most water when it is needed the most — when the weather is sunny and dry.

“The water from the well is now very good,” says Jurail as she collects water from one of the taps. “It’s clear and clean. You can’t compare them to our traditional wells.”

Indications are health conditions here have improved since the system was installed. AMORE workers say that prior to the project’s implementation, the Tongkil municipal health office had told them that four out of 100 people fell sick because of one waterborne illness or another. But since the project’s completion, no cases of such diseases have been recorded.

Mayor Sahidulla also says the system has helped the island so much that grateful — and relieved — villagers have offered prayers to thank Allah for the potable water that they now enjoy. Seconds Muhalli: “Its Allah’s gift to us. He answered our prayers. Villagers were overwhelmed. The clean water resources became (the) talk of the town.”

And probably the rest of Sulu, where even the capital has been having problems with a steady water supply since the 1980s. Recently, though, another community in the province received an AMORE water project. Although not solar-powered, the system installed in Siasi town is bigger than Kahikukuk’s, with 17 communal distribution points and transmission pipes that run more than 7,000 meters. (Siasi’s gravity-type water system is spring-fed.)

But residents here are content with their modest system. They even say that so long as the sun shines, they will have water.

They now only use water from deep wells to do laundry. And with less time spent fetching water (and digging wells), families have been bonding more even though parents allocate additional hours to work.

Teacher Muhalli waxes poetic when he talks about what they have now. “Water is the life of man,” he says. “Safe water is as precious as my boys.”

• I want my MDGs
• Whither the MDGs?
• Toilet trouble
• An island slakes its thirst
• Naga City’s class act
• A school board makeover
• Making sure Mama makes it
• No cure for costly medicines?
  Draft law affirms patient rights of drug firms
• Arroyo fails COA audit: Fairness of President’s books ‘doubtful’
• Gloria’s spending spree: Travel, ‘donations’ top Palace expenses
• First Person
  Still reeling from military junta, Burma a mess after cyclone
• Perspective
  An absolute privilege

IT WON’T be over even after the lady signs. And even after she signs it, the fight for popular access to affordable medicines won’t be over.

All that the cheaper medicines bill needs to be enacted into law is the signature of President Gloria Macapagal Arroyo. But some legal experts lament that as enrolled, the bill passed by Congress bears “imperfections” that effectively affirm the patent rights of big pharmaceutical companies over public health, a major hurdle to bringing down drug prices.

And while the bill introduced amendments to the Philippines’s intellectual property law, the weak and flabby wording of some provisions could challenge implementation, and keep the promise of cheaper drugs locked in litigation.

Lawyer Elpidio Peria, for one, says that as soon as Arroyo signs the bill into law, the battle shifts to the drafting of its specific implementing rules and regulations or IRR. And that, he says, should teach public-health advocates to study intellectual property issues in the pharmaceutical sector more judiciously.

Peria, an associate of the Third World Network (TWN), one of the nongovernmental organizations that had supported the Senate version of the bill, says that the drafting of the law offers one lesson: It is “dangerous” to leave the debate on intractable intellectual property issues to lawyers and policymakers alone.

“The (bicameral) debates only proved the esoteric nature of intellectual property, which makes it dangerous to be left to lawyers and policymakers,” says Peria. “The (Intellectual Property) Code amendments will now have to be scrutinized closely so that its imperfections might be augmented by the IRR.”

HAVE patent rights triumphed over public health?

Throughout the debate, public-health advocates and legal experts had welcomed the inclusion of amendments to the country’s intellectual property law in the final bicameral draft of the affordable medicines bill.

Undersecretary Alexander Padilla of the Department of Health (DoH) himself says that while the bill lost some of the provisions his department had championed, what is important now is that the law would contain “the more important patent flexibilities.”

The global nonprofit organization Oxfam International also says that, if applied by the government, the IP amendments “should help ensure that patent privileges of drug companies do not get in the way of promoting and protecting public health through affordable medicines.”

Yet the likes of Peria worry that the “simplistic debates” on price regulation and the Generics Act amendments had obscured the bill’s IP provisions. As a result, Peria notes, the IP amendments were not fine-tuned and rid of their inherent weaknesses.

Some legal experts now fear that despite its promise of affordable medicines, the law would face difficulties in its implementation, in large part because pharmaceutical companies could take advantage of the loopholes in the patent-related amendments.

Scuffles over ‘generics-only’

Up until the bill’s ratification by Congress in late April, the bicameral debates had focused mostly on the provision of House Bill 2844 that said only the generic names of medicines would appear on medical, dental, and veterinary prescriptions. This raised a howl among doctors who even threatened to declare a “hospital holiday” if the stipulation — which was among those being pushed by the health department — was not removed.

Later, the legislators wrestled over the House of Representatives’s proposal to create a drug price regulatory board. This further delayed the passage of the bill, which had been certified as urgent by the Arroyo administration way back in 2001.

In the end, the “generics-only” provision was dropped and the price-regulation board was replaced with a price monitoring and control mechanism that places the sole authority to impose price ceilings on the President, upon recommendation of the health secretary.

There were loud grumbles about a “watered-down” bill, but many also took comfort in the retention of several key provisions, including those on intellectual property.

“I would have been happier with the inclusion of the generics-only provision,” says Akbayan party-list Rep. Ana Theresia Hontiveros-Baraquel. But she is nonetheless pleased that the IP Code amendments, which were the intent of the original bill she filed in the House, were adopted.

Ireneo Galicia, former deputy director general of the Intellectual Property Office (IPO), also says he can live with the changes in the price control and generics provisions knowing how “politically” sensitive these issues are, as long as his main advocacy, the IP amendments on patent reforms, are intact.

“No doubt,” he says, “these will help immediately bring about the lowering of prices of patented medicines via the parallel importation provision, and in the long term via the early working and new use provisions.”

Drug patent provisions

For sure, the IP provisions included in the final draft of the bicameral bill are formidable. These include:

• adopting the principle of international exhaustion of intellectual property rights (IPR) for drugs and medicines to improve access to cheaply priced drugs anywhere in the world without risk of patent infringement;
• narrowing the definition of what medicines can be patented by disallowing the practice of evergreening — patent coverage for “new uses” of existing, already patented substances;
• providing for a broad parallel importation provision to allow the government to procure quality, affordable patented drugs and medicines from other countries;
• providing additional means to issue compulsory licenses so that the government can easily set aside patent restrictions in response to public health threats; and
• adopting an “early working” or Bolar provision, which ensures that affordable versions of patented medicines can be introduced into the Philippines market immediately upon patent expiration.

The bicameral version also adopted Section 93-A that was introduced in the House bill, which provides an alternative procedure for the issuance of a special compulsory license under the framework of the Trade-Related Aspects of Intellectual Property Rights (TRIPS) Agreement.

The IPO itself has declared that these amendments are a legitimate exercise of the flexibilities accorded to developing countries like the Philippines in the Doha Declaration on the TRIPS and Public Health.

The World Trade Organization (WTO) had adopted the TRIPS Agreement in November 2001. More than six years later, however, such flexibilities have yet to be incorporated in Philippine intellectual property law that would have made it more responsive to the problem of inaccessible medicines and expensive drug prices.

Hole-ridden amendments?

Lawyer Peria says he is happy that the IP amendments made it to the final draft of the bill. But he echoes other experts in pointing out some of these are likely to face challenges from pharmaceutical companies in court. Congress should have strengthened these so they could withstand such challenges, he says.

In fact, from the outset, multinational drug companies, particularly those represented by the Pharmaceutical and Healthcare Association of the Philippines (PHAP), had opposed the proposed amendments to the intellectual property law. As the drug companies see it, these would weaken the country’s patent system.

In PHAP’s 27-page position paper submitted to Congress during deliberations on the bill, 17 pages were devoted to the changes in the IP Code, arguing that these are discriminatory and violative of the due process and equal protection clauses of the Constitution. It also said that these were inconsistent with the country’s international treaty obligations of the Philippines.

These days, Peria’s organization, TWN, has made known its concerns over the final draft’s Section 72, which is on the international exhaustion of patent rights. Peria says this provision was weakened when the bicameral panel opted to retain the national exhaustion principle by inserting the phrase “in the Philippines.” He says this provides patent owners with additional ammunition for litigation as they can argue that the national exhaustion rule still applies in specific circumstances when there is a patent existing in the Philippines for the drug in question.

Section 72.4 on the “early working” or Bolar provision adopted from the House bill, meanwhile, is also weak since it copied the data protection provisions of Article 39.3 of the TRIPS Agreement without its key provisos, says Peria.

These provisos, he explains, stipulate that data protection applies only to new chemical entities and that it should involve data generated through a considerable effort and investment. Without these, the section practically imposes higher levels of intellectual property protection — also known as TRIPS-plus rules — that tend to undermine or weaken the public-health safeguards allowed under TRIPS.

The same is true of Section 74 in regard to government’s use of an invention, says Peria, as it qualifies the public non-commercial use of the patent by the government with the phrase “without satisfactory reason.” This, the lawyer says, is an additional requirement that is not found in the TRIPS Agreement.

And while Peria says that a stipulation allowing government use in case demand for the patented medicines is not met is good, it could be subjected to litigation by the patent-holder because of the phrase “to an adequate extent and on reasonable terms.”

Tripping on TRIPS

Another problematic amendment is Section 93-A regarding the grant of a “special” compulsory license. The provision, he says, “operationalizes” Paragraph 6 of the Doha Declaration on TRIPS and Public Health that calls for making effective use of compulsory licensing by countries with insufficient or no drug manufacturing capacity.

Peria says that legislators may not have realized the international implication of their action when they “unwittingly” grafted to this section Article 31 bis. He says this is an amendment to the TRIPS Agreement that was meant as a “permanent solution” to the issues raised in relation to Paragraph 6 of the Doha Declaration.

In an August 30, 2003 decision, the WTO General Council proposed a “temporary solution” by waiving the limitation that compulsory licenses should be predominantly for the supply of the domestic market. But patent experts and public-interest health groups criticized the decision, noting that it also imposed several conditions and procedures for generics exporters and importers that were largely seen as hindering access to medicines.

Essentially, what Article 31 bis does is to remove this limitation on the grant of compulsory licenses. But Peria says that by calling it “special,” Section 93-A is a “misapprehension” of Paragraph 6 of the Doha Declaration.

“(Paragraph 6) doesn’t refer to the license, but to the process that may be undergone by a country that accepts the Article 31 bis amendment to the TRIPS Agreement,” he explains. “What does that make of the other compulsory licenses in the other provisions of the IP Code? Is there basis for that distinction? Without any basis, the provision can be easily questioned in court.”

Besides, the amendment has yet to come into force, with less than two-thirds of WTO member-nations ratifying it.

Other potentially litigious amendments, says TWN, are the anti-evergreening provisions found in Sections 22 (on Non-Patentable Inventions from HB 2844) and 26 (on Inventive Step from SB 1658). Patterned after amendments in the India Patents Law, both sections exclude from patent protection “new uses” of a previously patented product or process. This addresses the phenomenon of “evergreening,” which consists of the patenting of minor changes to existing products (e.g., formulations, dosage forms, polymorphs, salts, etc.) thereby artificially extending the protection conferred by the original patent over a drug.

Peria says that what legislators might have thought of as double protection against the proliferation of frivolous patents on just about any demonstrable “new use” could be construed as a case of double standards. PHAP, which has insisted that the current IP Code has sufficient safeguards against double patenting and evergreening, may well question these provisions for making it doubly difficult for drug firms to comply, he says.

A veiled US warning?

Heightening worries of public-health advocates regarding the IP amendments is the release last month — just as the bicameral debates on the bill were winding up — of the annual IP report of the U.S. Trade Representative (USTR).

The report highlights, among others, the need for proper implementation of the TRIPS Agreement by developed and developing country-members of the WTO. According to the United States, it will consider all options, including (but not limited to) initiation of dispute settlement consultations in cases where countries do not appear to have implemented fully their obligations under the agreement.

Yet while the Philippines is on its Watch List, the USTR’s concern is more on the apparent increase in piracy cases, particularly concerning books, as well as illegal downloads using mobile devices and the Internet, and illegal camcording of films in cinemas.

Still, the report’s comments on Thailand, which remains on the USTR’s Priority Watch List, could be a veiled warning to the Philippines. After all, the report cites the “overall deterioration” in Thailand of IP rights protection, which includes the use of compulsory licenses to produce cheaper versions of patented medicines.

The USTR has urged Thailand to respect the viability of the existing patent system. It sides with the developed-nation pharmaceutical industry that has expressed concern that “the use of such licenses in mid-size economies such as Thailand could inflict economic harm on the industry and its ability to carry out research and development.”

The Office of the U.S. Trade Representative was suspected of attempting to modify some of the provisions in House Bill 2844 during the deliberations prior to its passage on third and final reading last year. An unsigned position paper circulated among members of the Lower House’s trade and industry committee was traced to the USTR based on references in the paper to U.S. “modern free trade agreements.”

The paper had called the legislators’ attention to the strict definition of patentability and the provision on the government’s use of compulsory licensing in the House bill.

• I want my MDGs
• Whither the MDGs?
• Toilet trouble
• An island slakes its thirst
• Naga City’s class act
• A school board makeover
• Making sure Mama makes it
• No cure for costly medicines?
  Draft law affirms patient rights of drug firms
• Arroyo fails COA audit: Fairness of President’s books ‘doubtful’
• Gloria’s spending spree: Travel, ‘donations’ top Palace expenses
• First Person
  Still reeling from military junta, Burma a mess after cyclone
• Perspective
  An absolute privilege

MDGS? WHAT MDGs?

For the last several months we have been swimming in an alphabet soup of acronyms — NBN, ZTE, NEDA, FG, FGI, to name a few. And more keep pouring in; these days, the most oft-repeated one is NFA, or the National Food Authority. Yet what we should have been repeating like a mantra is MDG and its plural form, which stands for Millennium Development Goals. In 2000, the Philippines became one of the signatories to the Millennium Declaration, thereby sealing its commitment to meeting by 2015 eight goals that address development concerns worldwide. Last year marked the midpoint in the period allotted to the achievement of these MDGs.

In its progress report on the MDGs that it launched last October, the Philippine government said there may be trouble ahead regarding targets for achieving universal primary education (goal number 2), as well as those on improving maternal health (goal five), specifically improving the maternal mortality ratio and increasing access to reproductive health services. But it also said that there was a high probability of meeting most of the other targets for the rest of the goals, which are: eradicating extreme poverty and hunger (goal 1); promoting gender equality and empowering women (goal 2); reducing child mortality (goal 4); combating HIV/AIDS, malaria, and other diseases (goal 6); ensuring environmental sustainability (goal 7); and developing a global partnership for development (goal 8).

Even in October, the Philippine midterm progress report made economists and development experts blink and purse their lips. Today, just a few months later, the furrows on their brows have also deepened.

On January 31, 2008 the National Statistical Coordination Board (NSCB) reported an increase of 7.3 percent in the GDP for 2007. Less than two months later, the NSCB said that poverty had worsened between 2003 and 2006. During the recently concluded Philippine Development Forum, representatives of donor institutions and countries asked repeatedly: “How come there is rising poverty and hunger in the midst of growth?”

Before the statistics on worsening poverty broke out, rosy projections about the future and the MDGs were also threatened with fears about a looming U.S. recession and increases in the price of oil. These developments cannot help but have a profound impact on the attainment of the MDGs by 2015.

TO BE fair, the high probability of attaining most of the targets hold true for national figures. But the picture changes dramatically when data are broken down to the local level. The wide disparities among regions, provinces, and municipalities are vast and seemingly insurmountable. The Philippine midterm report itself recognized the yawning gaps across regions. Among the challenges it identified were the high population growth rate, the low performance of the agricultural sector, the weak implementation of basic education and health reforms, and lax enforcement of laws. It also noted the problems with the financing gap, the capacity of local governments, transparency and accountability, peace and security issues, public-private partnerships, and targeting, database, and monitoring.

But perhaps what has to be scrutinized first is the mystery of worsening poverty amid supposed economic growth. After all, eradicating poverty is Goal No. 1, with its more specific targets being to reduce by half the proportion of people living on less than a dollar a day, as well as those suffering from hunger. The level of success in achieving this goal has a profound impact on the rest of the MDGs.

Yet no less than government statistics confirm the worsening of poverty. The twin threats of a looming rice crisis and global warming also do not warrant the happy prediction of a high probability of meeting the goal in nutrition — and especially not when surveys of the Social Weather Stations reflect persistent high levels of hunger, particularly in the National Capital Region (NCR) and in the Autonomous Region of Muslim Mindanao (ARMM).

In 2003, the government counted four million families as poor. By 2006, that figure had gone up to 4.7 million. This translates to 27.6 million wretched souls. The poverty threshold for the same year went up from P12,309 per capita annual income to P15,057.

Even worse, the number of the subsistence poor or absolutely poor has been rising. There are now 11 million families or 14.6 million individuals who belong to this category.

To quote the NSCB, “In terms of poverty incidence among population, out of 100 Filipinos, 33 were poor in 2006, compared to 30 in 2003.” This means a full third of the population! No wonder even the usually sedate and diplomatic representatives of foreign institutions and donor countries expressed utmost concern and repeatedly raised the issue during the Philippine Development Forum.

Here are more depressing statistics: In 2003, official figures indicated that 56.9 percent of households have per capita intake below the 100 percent dietary requirement. Given the other economic data, it is likely that proportion has become bigger. In more pedestrian terms, more than half of households are not getting adequate nutrition.

Yet the government keeps on saying that the country is experiencing unprecedented economic growth.

What officials may be refusing to see is that growth can only be meaningful if it results in increased incomes, more jobs, and stable prices for the man on the street. Among the initial questions that should be asked then are: Where is the growth coming from? Who are the main beneficiaries? These are crucial queries because the state of the economy cannot be separated from the state of social development, particularly the MDGs. Like the MDG numbers, while the national totals look good, they raise worries when disaggregated.

WE NOW see that the agriculture, forestry, and fishery sector registered the lowest rate of growth at 5.1 percent. Unfortunately, most Filipinos, particularly the poor, are in this sector. In the meantime, the rate of growth of industry is at 6.6 percent while the service sector is highest at 8.7 percent. Unfortunately, the poor are not necessarily in this sector.

The rate of growth of the subsectors presents a sobering picture. The forestry subsector has a very high growth rate of 12.2 percent, with agriculture lagging far, far behind. This has implications for Goal No. 7 on ensuring environmental sustainability. Global warming and massive flooding are wreaking untold damage in Quezon, the Bicol provinces, Leyte, and Samar.

In the industry sector, the subsector of mining and quarrying registered the all-time highest growth of 25 percent. Which leads to another important question: “What precautions have been taken about the environment?”

The subsector of manufacturing has the lowest rate of growth at 3.3 percent. Ironically, it is this subsector that employs huge numbers of workers. The drop in rate is probably due to the closure of many export-oriented firms across the country, including in the export-dependent province of Cebu.

The attainment of the MDG on poverty cannot be separated from issue of unemployment and underemployment. It is alarming to note that the NCR, which has the densest population in the country, has the lowest employment rate at 89.4 percent. Put in another way, the NCR has the highest unemployment rate at 10.6 percent. Once one realizes that, then it is no longer a surprise that the NCR has high levels of hunger. What the government should keep in mind, though, is that hunger and unemployment form a very dangerous and volatile combination.

Put graft and corruption into that mix and one would have a ticking social bomb. But since the release of the Philippine midterm report on the MDGs, the issue of combating has become even more urgent. The scandal-ridden national broadband network deal alone has shown how billions of pesos can be lost to corruption.

Corruption is no different from a social cancer that eats away at institutions, destroys the credibility of the government, and diverts huge sums of money from public services to the pockets of a few. In the process, it also diverts funds that should have gone into meeting the MDGs.

Corruption is not only rampant in economic development expenditures. It is also prevalent in MDG-related activities. The biggest corruption scandals that have rocked the country are about funds that could have been used for MDGs, particularly poverty reduction. Take the P769-million fertilizer scam that began as an attempt to increase agricultural productivity. Take the P34 billion recovered (and now missing?) Marcos money that could have been used for agrarian reform. Take the series of textbook scandals and the nauseating corruption in drug purchase and distribution. Imagine the number of lives that could have been saved and lifted from poverty had these funds been used properly. A war on corruption is a war for the MDGs.

AS IT is, funds for the MDGs are often lacking, a fact that obviously poses yet another obstacle in achieving the goals. Since 2006, Social Watch Philippines has been coordinating the Alternative Budget Initiative (ABI), which is presently composed of 48 civil-society groups, along with supportive legislators from both Houses of Congress. At present, civil society participation in the budget process is recognized in two House resolutions. During the deliberations for the 2008 budget, the alternative budget was duly presented and discussed by the Appropriations Committee. (Truly, a first in the history of Philippine budgeting!)

The initiative, which was supported by the United Nations Development Programme (UNDP) through the National Economic Development Authority (NEDA), succeeded in increasing allocations for MDGs by P5.3 billion in the 2007 budget and P5.9 billion in the 2008 budget. The latter does not include additional allocations for state colleges and universities, but the extra billions of pesos are still a plus for the MDGs.

Still, hurdles upon hurdles keep appearing on the road toward achieving the MDGs. The capacity of countries to achieve development is constrained by issues related to trade, debt, and new technologies, as well as decent and productive work for youth. Unless firm and decisive action is undertaken, the Philippines will not have enough funds and technology to cope with the threats and challenges to the MDGs, as well as changing needs for these.

The capacity of developing countries like the Philippines to attain the MDGs is also largely dependent on how global partnership develops. Very often, the question is asked: why can’t the MDGs be attained? A great part of the answer lies in Goal No. 8, which is on developing a global partnership for development.

During the early years of implementation of the MDG campaign, a simplistic division of labor was established informally: The first seven goals are the responsibility of the developing countries while the last goal is that of the developed countries. Goal No. 8, however, has neither firm targets nor fixed timetables. How then can progress be tracked in its implementation when there are no benchmarks and measures to go by?

The nebulous nature of Goal No. 8, however, should not be used by the government as an excuse for falling short of the targets for the rest of the MDGs. Indeed, among the most urgent tasks at hand is revisiting the projections and identifying the regions and provinces where poverty, hunger, and malnutrition are most prevalent.

This is no time to be complacent; whatever gains that have been attained in the last seven years can be wiped out by the onslaught of challenges facing the MDGs. It may even well be that instead of eradicating extreme poverty and hunger, the government may end up eradicating the extremely poor and the desperately hungry.

Tempus fugit.

Leonor Magtolis Briones was formerly the country’s national treasurer. She is currently a professor at the National College of Public Administration and Governance at the University of the Philippines, Diliman, and co-convenor of Social Watch Philippines, which is part of a global network that monitors the implementation of government commitments to social development.

RESIDENTS of the Southville Housing Project, a government relocation site in Cabuyao, Laguna, used to live next to a dumpsite and had to resort to wearing a mask to avoid its harmful and unbearable stench. [photo by Alecks P. Pabico]

Poisoning is a global problem, and as our world becomes more complex, the risk of poisoning has increased. Yet it is highly likely that poisoning cases are underdiagnosed, partly because we know so little about the effects of small doses of chemicals during the development of our bodies. Recall that it was only three decades ago that we realized the hazards posed by lead, which had been a popular ingredient in paint and other everyday objects. By then generations had been exposed to the substance, which in toxic levels can cause retarded mental growth in children and can mimic intestinal parasitism (abdominal colic and anemia).

Still, even today, some people apparently have failed to heed warnings regarding the use of lead; in recent months, for instance, the major U.S. toy manufacturer Mattel was forced to recall thousands of its products after discovering that a subcontractor in China had used lead paint on the toys.

The Mattel case highlights the fact that in many instances, poisoning is entirely preventable; there are, however, factors that need to be present. Experience has shown us again and again that outside of malicious intent, poisoning occurs mainly because of ignorance, complacency, and the human compulsion to take unnecessary risks.

Access to the right information is thus vital in the prevention of poisoning. Vigilance, which seemed to be instrumental in avoiding disaster in the Mattel case, is needed as well. So, too, is caution, especially in these times.

There are many kinds of toxicants. These days, we are often unaware of the natural toxins found in the environment, including those in plants; there is even a growing popular perception that anything that is “all-natural” must be good, and therefore safe. Yet there are the likes of cassava, which, if processed improperly, can cause cyanide intoxication.

Interestingly enough, ancient civilizations possessed a wide range of knowledge regarding natural poisons and used this in their daily lives, from hunting to rituals, to curing illnesses. The first documentation of the use of natural poisons for their medicinal properties was found in Egyptian papyrus scrolls that scholars believed were from 1550 B.C. The Greeks and Romans later used poisons in political activities and in executions.

From the Middle Ages to the Renaissance period, political assassinations were often carried out with poisons. In the 19th century, the Spanish chemist and physician Mateo Josep Bonaventura Orfila published Traite des Poisons, which described his scientific procedures in testing animals and developing methods for the chemical analysis of poisons in body fluids and tissues. The groundbreaking work correlated biological and chemical information, paving the way for modern toxicology and the application of analytical procedures in forensic science.

TODAY WE are more conscious of the hazards posed by chemicals in manufactured products such as household and industrial cleaners and agricultural pesticides. But there are times when we are careless in the way we use and store these. Our attitude toward pharmaceuticals also leaves much to be desired, since far too many of us tend to assume that just because medicines are supposed to be part of the treatment of illnesses, all their effects are beneficial.

At the same time, there are far too many who should know better yet even help others put themselves at risk. Case in point: drugstores that sell prescription medicine to people who are unable to show a doctor’s prescription. This is a dangerous practice since it can lead to the misuse of the medicine, including overdosing. Isoniazid, an antituberculosis drug, is particularly nasty when taken in an amount that is more than what is needed: It can cause metabolic acidosis, convulsions, coma, and death.

Vanity has also become hazardous to our health. Men wanting to look muscular have been persuaded to take anabolic steroids that result in life-threatening liver shutdowns. Women and even young girls obsessed with keeping their figures trim have turned to unregistered slimming pills that can cause serious catabolic and toxic physiological changes in the body, damage the cardiovascular system, and even perversely alter one’s psychological makeup. I once gave a talk at an exclusive girls’ school some years back and was surprised that teenaged girls were using such pills. I was more shocked to find out that the girls’ mothers were the ones who convinced them to use the pills in the first place.

The danger lurking underneath an obsession over appearances exists as well in the grocery and palengke (wet market). To entice more buyers, some unscrupulous farmers and vendors resort to chemicals to enhance the way their produce look. In the last decade or so, there have been several media reports on the use of formalin and petroleum on vegetables and fish. The purported reason: to preserve the “freshness” of the produce. The other effect, however, is additional toxicity to what is supposed to be a source of nourishment.

In our 24/7 world, we have also heard of “toxic schedules” and “toxic jobs,” referring to a high-pressure atmosphere in the workplace. But there are jobs that expose workers to literal poisoning, which can actually be prevented with the right safety equipment and procedures. Solvents, for instance, are the most commonly used chemicals in industrial processes. Although they come in different chemical formulations, they uniformly affect the nervous and blood systems, as well as the liver, heart, and the respiratory system.

Unfortunately, companies are not uniform in their efforts to keep the workplace safe from chemical pollution, and their employees from the risks of being exposed to solvents. One way to find out if a company is compliant with safety standards is to ask their workers what “MSDS” and “PPE” mean. MSDS stands for material safety data sheet, which provides information about how chemical substances should be handled, as well as its toxicity and health effects, and first aid procedures, among other things. PPE is short for personal protective equipment, or gear that a company should provide to keep an individual in its premises free from harm.

Mining is another occupation that exposes the worker to all sorts of risks. In terms of poisoning, we have seen sulfide inhalational exposure among miners working in geothermal sites. Sulfide emits a strong rotten egg odor, but over time — under chronic low-dose exposure — workers lose the ability to tell if there is a high leakage of this gas. Inhalation of sulfide can alter the configuration of our hemoglobin so that these cannot be relied upon to carry precious oxygen to vital tissues and organs, thereby leading to convulsions, metabolic acidosis, and cardiovascular collapse.

Almost two decades ago, there was a mining boom in Mindanao. The method used in mining the gold, however, was the inefficient, crude, and dangerous mercury extraction process, in which mercury vapors were released into the environment and contaminated communities. The predominant toxicity of mercury is nervous system damage. (And while we know that schoolteachers do not have it easy, last year teachers and students alike were put at risk of mercury poisoning during a science experiment gone terribly wrong in a school in Parañaque. Several students and school personnel, including teachers, had to seek medical help; the school was ordered closed for days so that it could be cleaned thoroughly.)

Then there are careers like firefighting, which exposes one to the risk of carbon monoxide inhalational poisoning. This is the same hazard, though, that threatens drivers who do not maintain their vehicles.

YET EVEN a jeepney driver who religiously keeps his vehicle in tiptop shape may not be free from falling sick from inhaling air that is heavily polluted by fumes from smoke-belching cars, trucks, motorcycles, and yes, jeeps. Neither would a well-conditioned athlete, apparently. Just recently, officials of the 2008 Olympic Summer Games that will be held in Beijing voiced their worries over what could happen to athletes who would be competing while breathing in the toxic air in the Chinese capital. One of the costs of China’s new prosperity is air pollution, brought about not only by its multiplying factories and coal-fired plants, but also by its citizens’ growing fondness for cars and more cars.

It’s a problem that is certainly not unfamiliar to Filipinos, many of whom now have respiratory ailments because of the deteriorating air quality of our cities and towns. But it’s not only the air that we have managed to poison; industrial and household waste — some of which contain chemicals that are carcinogenic — have turned our seas, rivers, and lakes into toxic soups. This raises the risks that the fish, clams, and crabs that we put on our dinner tables could well send us to the hospital.

There is no doubt that we are part of the reason why new forms of poisoning are emerging at an ever-increasing pace. That’s the bad news. The worse news is that the Philippines has been slow in producing the human and technical resources needed to address the multiplying problems of poisoning. In a country where doctors are willing to retrain as nurses just so they can work abroad, the field of toxicology is unattractive from an economic perspective even when compared to other medical specialties. Analytical laboratory systems are also poorly developed, and the few labs that exist could use regular quality-control checks. Not surprisingly, problems of toxicology are approached in a reactive, instead of a preventive, manner. Local toxicology research has also lagged behind those on other health issues.

There is weak government incentive to invest in toxicology because it is perceived to be a low priority when compared to other public-health problems in a resource-poor country. The number of local toxicology cases is supposedly small; even the pharmaceutical industry, in fact, has been reluctant to invest in service-item, yet “orphan” drugs that are used to treat many cases of poisoning. As a result, access to antidotes is low — that is, if these are available at all.

For instance, we used to have antidotes for the envenomation from cobras, which can paralyze their victims, the most common of whom include soldiers, forest rangers, agricultural workers, and golf caddies. Today we are often short of these life-saving antidotes, and that is due most probably to the drug industry’s assessment that producing these would just result in a poor return of investment. The Research Institute of Tropical Medicine (RITM) does produce some 5,000 vials of cobra antivenom a year, but it usually runs out of stock after a few months.

The statistics on toxicology cases, however, may be grossly inaccurate, given the lack of hospital resources and expertise to deal with these. Since the figures count only the cases attended to, it leaves out those that were sent elsewhere for some reason or another, or those that were misdiagnosed altogether. Excluded, too, are poison victims who failed to get medical help on time and those who opted not to seek help at all.

For sure toxicologists need to be communicators in their community and to be always on the ready to provide their services — whether or not these are appreciated. We need to explain to people the role of toxicology in our everyday lives. But we also need to emphasize that toxicology is a shared responsibility of the government, industry, and the sciences. The current lack of coordination and the seemingly neglected investment on toxicology has only placed us unnecessarily in harm’s way.

Dr. Kenneth Hartigan-Go is a medical toxicologist who is connected with the Ateneo School of Medicine and Public Health and Medical City. For more information about poisons, contact the National Poisons Center at telephone number 524-1078 or write to the Philippine Society of Clinical and Occupational Toxicology, Inc., c/o NPCMC Ward 14-A, Philippine General Hospital, Taft Ave. Manila.

THE writer with two of the “pushy” females in his life.

I HAVE three things in common with former president and certified macho man Joseph ‘Erap’ Estrada: the same birthday, facial hair, and the constant presence of women. But while he may believe being constantly around women is a good thing and could be a much needed boost to one’s masculinity, it’s a situation I have ambivalent feelings about.

Well, I probably won’t have that dilemma if we were talking in terms of a harem, where all the world is made to revolve around one truly lucky guy, the center of attention of sensual ladies (wives and servants) whose job it is to always ensure his personal satisfaction. But a harem — at least, as far as Western writings imagined it to be — is so archaic an arrangement, and chauvinistic at that. Besides I’m no royal, blue-blooded heir of a sultan. My only dubious link to royalty is the name I was christened with, one I share with my dearly departed father and two younger brothers: that of a Macedonian hunk of a conqueror and emperor who was also said to have loved males more passionately than his wives. Hmmm …

But I digress. As I was saying, I’m surrounded by females round the clock, every single day of my chaotic life, and most times I feel like I’m in an unenviable position. Over at our humble Tandang Sora abode, members of the female species outnumber me three to one: my wife Mira and our two daughters, Marlee, 10, and Kaya, five. At work, I am the only male employee in an office that has always suffered from gender imbalance since it was set up almost two decades ago. In fact, it was only when I joined the PCIJ back in 1994 that the center’s male staff population swelled to a high of three. But the number would soon dwindle back to two when Howie Severino left in 1997 to join GMA-7 to venture into broadcast journalism, and to just my solitary self late last year when we had to let go of our driver-messenger.

I say unenviable because I haven’t been dealing with ordinary females here. My colleagues at the PCIJ, past and present, are strong and aggressive women who do not subscribe to the myth of male superiority. That is why I’ve always maintained that the women’s liberation movement had long raised the flag of victory in its struggle for gender equality over at the Center.

So it is at home with Mira and already to some extent our two daughters, who both exhibited a discomfortingly mean streak at an early age by yelling “Ayoko sa ‘yo! (I don’t like you!)” whenever they woke up in the morning and the first thing they saw was me. (Who wouldn’t?)

That morning ritual is already a thing of the past now that they’ve grown into adorable young girls. But, like their mother, they surely know how to demand my attention, albeit in contrasting ways. Marlee often resorts to silent, irritating tantrums, while Kaya is the screaming banshee foreboding my impending doom should I fail to comprehend or miss out on something she said.

Not that I’m really complaining about the “pushy” females in my life. My personal and professional relationships with them, I do acknowledge, have only made me strive to become a better man, or person. But I think it helped that I was also somehow brought up as a “soft” man — the ’90s term for males trying to get in touch with their sensitive side.

AS THE second child in a brood of six (three girls and three boys) and the eldest among the boys, I assumed more responsibilities compared to my sisters, something not quite typical of a Filipino family. In our household, my sisters had it easy as they were confined only to the house to perform domestic chores. It was I who became my hardworking mother’s trusted assistant, who helped her tend our grocery store, dutifully ran errands for her, and even did the marketing. By the time I was just 11 or 12 years old, I already knew my way around the Divisoria market where we bought most of the goods we sold. I would wake up early to open the store, which was located in a neighborhood far from where we stayed, and attend to the morning sales before I went to my high school classes in the afternoon. After school, I would go straight to the store and mind the shop until it closed at 10 or 11 p.m.

Because both our parents worked, it was also not strange for my siblings and I to have learned to cope by ourselves. That’s how I acquired the skills of doing the laundry and ironing the clothes. Cooking came to me much later, although I believe it’s in my genes, an inheritance from my father who was quite a fantastic conjurer of gastronomical surprises.

These days, my part in the division of labor at home — given that we’ve renounced the need for a house help — consists mainly of washing the dishes, ironing the clothes, and bringing Kaya to her preschool (same as with Marlee when she was that age). Cooking rice and brewing our morning coffee are also part of my daily to-do list. I haven’t been able to whip up dishes as often as I’d like to but I make do occasionally. Meanwhile, domicile cleaning and maintenance, like child-rearing, is a partnership arrangement.

I also remember defying my father, a macho in the mold of Erap, who wanted me to engage a boy of my age in a fistfight because he had teased and made my younger sister cry. But it was just not in my nature to resort to a contest of valiant testosterones to resolve matters. Unfortunately, in those days, such hesitance was sure to mark one as being effeminate or even homosexual — something my father used to bring up to challenge my “manliness.” But he always ended up frustrated, and I kept all the bones in my hands unbroken (the better to type out stories, mop the floor, and stir the stew).

Perhaps my elementary years in an exclusive girls’ school — the Immaculate Conception Academy of Manila admitted boys from kindergarten up to Grade IV — somehow prepared me as well for my now predominantly female world of work and family. So when I reached college, societal change-seekers who at the same time question the culturally imposed concept that males are the superior gender appealed to me more.

WITHOUT THE baggage of a patriarchal mindset, it was therefore not difficult for me to shun men’s mythical superiority over women both at home and in the workplace. Decision-making is a shared responsibility between me and Mira in our partnership as husband and wife, as well as father and mother to our two daughters. Never did it bother me that my superiors at the PCIJ were females, even if they were more aggressive, more driven and competitive, some more adept at high-level mathematical abstractions than most men, including myself.

Not that I am an underachieving PCIJ staff (I’ve had my modest share of recognitions as one). But the old cultural assumptions of male superiority are simply out of touch with present-day realities. It has to be acknowledged that women, particularly in this day and age, can be as capable as men, or even better. In the same way that men can be as sensitive or nurturing as women, or probably even better.

It’s not surprising that to this day male superiority is still explained away as something natural, alluding to the differences between men and women that favor masculine attributes and denigrate the feminine. But studies have argued that men and women are not necessarily different as the differences rather vary from individual to individual. Whatever differences there are, researches have shown, are not absolute (save for the sex organs) and have more to do with biology. Men tend to be more aggressive because they generally have larger, stronger muscles. With this biological structure comes more muscle tension, which needs to be released in terms of activity. In comparison, female sensitivity and responsiveness to human situations are thought of as built-in feminine characteristics because they arise from this apparent absence of hormone and muscle tension that explains aggressiveness in men.

What women lack in aggressive behavior, they are said to compensate with the ability to engage in sustained activity — a behavior rooted in their distinct biological rhythms that in turn originated from the prehistoric division of labor that assigned the hunting task to men and the gathering to women. That probably explains the workaholic bent among women, particularly as I’ve been witness to at the PCIJ, and, well, maybe the “slave-driving” when they become bosses.

This just goes to show that even “enlightened” men still encounter rough sailing in the seas of estrogen that they have to navigate every day. In the main, it’s less stressful if you just roll along with the “givens” that have to do with other biological differences. Like when they have their monthly periods and the lunar influence is strongest, and so you just become their object of hate for no apparent reason (at least to me). There is also the midlife/menopausal phase to prepare for, although we’re now being told men go through menopause as well, and suffer midlife crises of their own.

I will not deny though that there were instances in the past when I felt a sense of being left out simply because I am male. Added to the fact that I was not part of the power structure then, I often wound up blissfully uninformed and uninvolved in whatever was being cooked up by the cabal of women around me. Even today, it is inevitable that I will get outvoted in many instances (yes, doing this piece was one of those). Thankfully, my collection of females at home gang up on me more to tease me, like exchanging whispers in my presence because they know I resent that.

Anyway, when all seems too unbearable in the land of women, there are enduring standards for male behavior that men can always resort to: strength and silence. I, however, take more to the latter. Not because I am a stereotypical man of few words. It’s just that women find it annoying.