MAKING A DIFFERENCE
Few are the men and women who dare to break away from the pack, and forge a path with their profound and lasting contributions that change the lives of many. MEDICAL OBSERVER salutes these special breed of doctors--many of whom aren't strangers to controversy, while all of them have wrestled seemingly insurmountable challenges, and emerged victorious. By no means are they the only ones in the medical community whose intelligence, determination, indefatigable spirit, courage, humility, and selflessness--their greatness--inspire others to aspire to greater heights. In a country sorely in need of heroes and models--and whose doctors and nurses are leaving in droves to find "the good life" in some other land, it warms one's heart to know there are doctors at home who are
DR RAMON ABARQUEZ, JR.
Cardiologist Ramon Abarquez Jr. has a mind as sharp as a surgeon's scalpel.
For more than half a century, he has been making incisive studies and prominent discoveries that have altered the medical world. His most significant work is the creation of the exercise electrocardiogram (ECG). Before its advent, recording ECG accurately was only possible by testing for it before and after a physical activity. Attempts to record it during exercise, using the conventional flat electrodes that were attached to the body, yielded unreliable readings, as the electrodes would also pick up electrical interferences from muscular movements.
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Abarquez, who was training in America at the time, was given a grant by the New York Heart Association to design an ECG test that would cancel out the extraneous noises, and would be used in preparation for space travel. He came up with a deceptively simple but ingenious electrode design that does the trick. Rubber tubings were cut and wires were soldered to form cups that replace the pads on the electrodes. It was, according to the Progressive in Cardiovascar Disease Journal, the "most important contribution to exercise ECG methodology." Since then, the technology has been integrated to commercial treadmill exercise that tests for ECG.
In another study, the doctor uncovered two pathways of hypertension--the slow onset, wherein the blood pressure (BP) rises from a normal of 140/90 to 160/95 across a span of several years, and the rapid onset, where a similar BP change occurs within a year.
During a ten-year follow-up with individuals who participated in the study, he found out that the mortality rate from heart attack was almost double in the slow-onset group. He then suggested--20 years before it was finally recognized in the international medical community--that the cut-off level for hypertension be lowered to the 140/90 mark, thus alerting patients and physicians earlier of potential heart failure.
As for the rationale behind the higher mortality rate among those with slow-onset hypertension, later studies showed that what is more relevant than the BP number is the presence of comorbid conditions or other risk factors, such as obesity, smoking, and diabetes.
The professor emeritus at the Unviversity of the Philippines, through extensive clinical tests, also found out that by treating hypertensive patients with antihypertension medication and digitalis or digoxin, the onset of left ventricular hypertrophy (LVH)--a complication of hypertension--can be prevented. LVH not only leaves areas of the brain oxygen-deprived, but also increases the likelihood of developing atrial fibrillation, which significantly reduces one's survival rate.
When testing for blood pressure in the industrial setting, an applicant's normal BP can sometimes mean that he has taken an antihypertension medicine. Abarquez devised the raised-arm maneuver (RAM) to distinguish applicants who are hypertensive from those who have normal BP. Due to endothelial dysfunction in hypertensive patients, the blood vessel constricts instead of dilating after the arm is dropped from a raised position. Thus, Abarquez concluded that in normotensive individuals, the post-RAM BP is lower than the pre-RAM BP. But among hypertensives, the post- RAM BP would remain equal to or even higher than the pre-RAM BP.
The scientist and academician shed more light on hypertension management with the "family affair" concept, which is based on his findings that family members living together share the same hypertensive risk factors.
Now 78, Abarquez is not planning to hang up his stethoscope yet. Aside from his medical practice, the two-time Who's Who list maker, Cultural Heritage awardee, and member of the National Academy of Science and Technology--the Mt. Everest for Filipino scientists--is busy studying and proposing revisions to international guidelines on hypertension management. And when he's ready to present his paper, the global medical community will be there to listen.
DR. CORAZON ALMIRANTE
When Dr. Corazon Yabes-Almirante set up the Perinatal Center, the first in Asia and one of the world's first housed inside a children's hospital--the Philippine Children's Medical Center--the obstetrician-gynecologist/perinatologist was not just making history. The Perinatal Center, which accepts only high-risk pregnancies, specifically those whose delivery is required at less than 34 weeks of gestation, has dramatically increased the chances of survival for mothers and their babies.
"Since the center started [in 1989], the infant mortality rate of 30 in 1,000 has decreased to seven in 1,000," she says. Just two years ago, in fact, the center held a reunion among the low-birth-weight babies it saved, many of whom got their fighting chance through the Safe Motherhood Referral Network in Quezon City, a program initiated by the doctor.
With the Perinatal Center as its hub, the network of Quezon City hospitals and the city health department's health centers and lying-in clinics facilitate the transfer of high-risk mothers and infants to the center. In the network's first 10 years of existence, the maternal mortality rate in Quezon City dropped by 42 percent. Through this system, Almirante discovered that transporting the mother rather than the infant boosts the survival chances of both the woman and the child. The downward trend in infant and maternal mortality is reflected on the nationwide level, as well, which she attributes to the training offered by the Perinatal Center to health professionals coming from different parts of the country.
Almirante is also the main force behind the Fetus as a Patient Institute, Philippines (FPIP), a leading proponent of antepartum fetal care. By being given pediatric care, including monitoring of blood sugar and electrolytes, the unborn increases its odds for a healthy delivery and childhood. The multidisciplinary team of FPIP also offers postgraduate courses on perinatal and neonatal critical care, fetal echocardiography, and obstetric ultrasound, which is a sensitive topic for Almirante.
As founder of the Philippine Society of Ultrasound in Clinical Medicine, she has met strong resistance since she began proposing the idea that general practitioners and nurses--primary health-care providers--once properly trained, should be allowed to perform ultrasound on pregnant women.
"Ultrasound is a powerful diagnostic tool. It is like stethoscope.... Here in PCMC, our ultrasound is open 24 hours a day. But in barrios and other rural areas, there are sometimes no OB-gyn. So who else can give the ultrasound?" she asks. Unfortunately, many hospitals won't even allow nonOB-GYN's to operate the machine for fetal screening.
But that may change, as Almirante isn't throwing in the towel yet, not when her goal is "to give world-class health care to every Filipino." The perinatologist, who is also the first to establish a pediatric and adolescent gynecology unit in the country, says, "It's not too ambitious if everyone is committed. It's not about the equipment; it's the training of health professionals," a challenge she has successfully undertaken and will continue to do so.
DR. ANTONIO DANS
Dr. Antonio Dans has come to accept the fact that he cuts a controversial figure, not because of his beliefs but how they have been wrongly interpreted. When he told a leading broadsheet recently that relying too much on specialists and too little on generalists drives the cost of health care up, the paper misquoted him as saying that "patients are at the mercy of overpriced specialists." He was alienated from some of his peers after that, but the cardiologist-turned-internist is taking a philosophical view to all these. His true friends won't always believe everything written or said about him, and maybe in time he will be vindicated. Maybe that moment has come.
Five years ago, Dans shifted from cardiology to general internal medicine when he found it very limiting to focus on treating the heart alone, sometimes ignoring other medical problems. "Many times, the financial situation demands prioritization of problems, but for a specialist, the main problem will always be the one he's trained to handle," he says. There's another potential pitfall: Drugs prescribed for one disease may exacerbate another condition--a problem sometimes missed when there is no physician who looks after the overall health of an individual.
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At this year's Philippine College of Physician's annual convention, where Dans was head of the scientific committee, the entire event was devoted to general internal medicine. The fierce advocate of holistic care knows too well that bucking the trend of specialization isn't going to be easy. He may have succeeded in convincing the University of the Philippines College of Medicine to form a section of adult medicine--which he heads--but the greatest battle is changing the perception of medical students and the public. Specialization isn't only where the money is, it is also considered a measure of a physician's skill. This poses a problem for rural communities, where the need for specialists is limited, hence specialists are less likely to choose to set up practice there.
Specialization can also cause an increase in the cost of care. "You have a doctor for your ulcer, a doctor for your diabetes, a doctor for your hypertension, a doctor for your arthritis, and another for your cholesterol, when in fact these five problems are very simple primary-care problems and should be taken care of by a properly trained internist," Dans insists.
Aside from his campaign for holistic care, the Lingkod Bayan awardee and Metrobank's "Most Outstanding Teacher" has been at the forefront of a struggle to regulate the ethically ambiguous relationship between doctors and pharmaceutical firms. The four-page guidelines he coauthored for the Philippine General Hospital Department of Medicine includes the voluntary inhibition of the faculty from accepting pure leisure, cash, and luxury items as gifts from pharmaceutical companies, an age-old practice of the profession that is sometimes done in exchange for prescribing the firm's products. For the past two years, the department has been the test bed for this self-regulatory movement. Once the faculty is convinced of its effectivity, the guidelines could be used by other universities, some of which have been requesting for copies. With guidelines such as these, it is hoped that the interests of patients will be better safeguarded in the future.
Dans is also the head of the Asia-Pacific Center for Evidence-Based Medicine, an organization that promotes the discipline of making sound clinical decisions through "the integration of best research evidence, clinical expertise, and patient values." He stresses the need for physicians to be more informed of the medicines before prescribing them. "For every 10,000 substances we test," he says, "only one comes out successful in actual medical practice." Through the center's efforts, which includes the creation of a comprehensive and up-to-date web-based resource for teaching and practicing evidence-based medicine, he hopes to see a compassionate, information-seeking medical community that provides patients with more effective and efficient health care.
DR. FE DEL MUNDO
People like Dr. Fe del Mundo are a vanishing breed. Their compassion for the underprivileged is almost saint-like and certainly not defined by how large their personal disposable income is. The pediatrician, whose lifelong devotion to provide marginalized children good quality health care, has more than once used her own limited funds to support her cause.
When the five-story Fe del Mundo Medical Center Foundation she established needed an elevator, she sold her home and put up PhP15,000. Years later, when its patients would greatly benefit from a blood bank, a laboratory, and an adult wing, the doctor placed her second house on the market to finance the construction of an annex building.
Accorded by the International Congress of Pediatricians the distinction of "Outstanding Physician and Humanitarian," she has not only eschewed what could be a lucrative profession, she has also devoted her entire practice to charity, despite living a "hand-to-mouth existence" during her youth. "All these years, I have worked with patients left and right, but I have never accepted a single centavo," the 94-year old doctor says. One of her staff later mentioned that all her professional fees go directly to the foundation. So how does the grand dame of pediatrics manage to live?
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Being the first Filipino woman to be conferred the much-coveted title of National Scientist in 1980 by the National Academy of Science and Technology (NAST), del Mundo receives from the NAST a monthly living allowance of PhP21,000, which she believes is more than enough for her personal needs. Her hospital is her home, an ideal setup that allows her to pursue her commitment to her patients every waking hour. The frail-looking physician still does the rounds in her wheelchair and welcomes patients even on Sundays. Though she's never been married and has no children of her own, her compassion for the children of lesser gods was first triggered when she worked on her theme paper in medical school. "My assignment was to go to a rural area--Marinduque--and survey the health of the people. I was [disturbed] by the fact that most of those who were taken to the cemetery were children rather than adults ... I knew there was much to be done," she recalls.
The University of the Philippines valedictorian in medicine became a presidential scholar under Manuel Quezon, who sent her off to Harvard University to pursue pediatrics. As the only female student and the first of the fairer sex to study in the prestigious medical school, she had to prove she was just as good as the rest of them, even if it meant borrowing all the relevant materials from the library ahead of everyone else; she thus went to class more prepared than the others. Eventually, she gained their respect, enough for them to ask her to practice in the United States instead. But she knew where her obligations were.
During the Second World War, del Mundo took care of the children prisoners, and later established a children's hospital in Manila, which grew into one of the largest government general hospitals today, the Jose Reyes Memorial Hospital. She also went around the depressed areas in the country, putting up about 150 children's rehydration centers.
The Ramon Magsaysay awardee for "Public Service by a Private Citizen"--Asia's answer to the Nobel Prize--organized the Philippine Medical Women's Association, cofounded the Philippine Pediatric Society, opened the not-for-profit Center for Tuberculosis in Children, and was the first woman president of the Philippine Medical Association. The latter owes its concrete structure to the doctor who raised funds while carrying a framed illustration of the planned building, the same way she did to generate money for the construction of her foundation's main building. It will outlive her, a testament to her inspiring and unwavering dedication to children.
DR. RICARDO FERNANDO
When Drs. Ricardo Fernando and Ramon Abarquez left for the United States after their residency, they made a pact: each would learn a specialty that was not yet available in the Philippines and introduce it back home. Fernando chose diabetology, a career move and a calling he didn't realize he would have to fight for decades. But his efforts would eventually be recognized by the Who's Who and the International Biographical Society for being a "Leading Health Professional in the World."
His first local study, a two-hour postmeal-blood-sugar test on a Tondo population, which revealed an 8.1-percent incidence of diabetes, drew the ire and derision of many physicians. "It was editorialized in a paper in PGH (Philippine General Hospital) that Fernando is creating diabetes," the 78-year-old doctor now recalls with amusement. Colleagues didn't even believe that diabetes existed among Filipinos, until a similar survey in Bataan made by a different group of researchers showed a 9.1-percent prevalence. "It was a hidden disease, and people were dying from heart, brain, and kidney problems--complications from chronic diabetes," he says.
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Thus, the doctor organized the first international diabetes conference in the country and, with the help of his mentors from the world's leading diabetic center at the time--Joslin Clinic--offered the first diabetes seminar here. Both had more than a good turnout, but establishing diabetology as a separate specialty from endocrinology would take more than just filling up conference halls. Endocrinologists were not keen, to say the least, on the diabetologist's proposal, which they perceived threatened their profession.
The more relevant issue for Fernando, though, was providing a well-informed and appropriate care for this disease. And there is also the question of health insurance for diabetes treatment. "At that time, HMOs (health-maintenance organizations) won't pay you if you're not a diabetologist trained for at least two to three years in a qualified diabetes center. Not even if you were an endocrinologist," he says.
With the help of friends in the academe, the future founder of the Philippine Society on Diabetes opened the doors of the University of the East Institute for Studies in Diabetes in 1989. "It still is the only institute for diabetes in the world," he states. The school not only faced possible closure, many of its graduates were initially ostracized by endocrinologists when they began their service in the provinces. Now, the institute is slated to transfer to its new and much larger home in Marikina--a two-story building on a 5,000-square meter lot. The institute is his labor of love; he doesn't receive a single cent from it.
Fernando, who organized the Philippine Association of Diabetes Educators and the Association of Diabetes Nurse Educators of the Philippines, holds two-day seminars four or five times a year for local doctors, dieticians, and nurses in rural areas as far as Mindanao. On a mountain in Bataan, the Rainbow Camp, a biannual weeklong event he spearheads, teaches children how to live with the disease.
"The diabetics of tomorrow will come from the children of today," he says, adding that his youngest patient is only two years old. To nip the problem in the bud, he's getting three-month-old babies of diabetic parents accustomed to the taste of vegetables, by prescribing a drop of pureed greens three times a day. He's passionate about it, just as he is with his "five commandments": no pork, no beef, no oil, no fats, and no sugar. A diabetic himself who looks trim and healthy, he is living proof that the diet works.
More than intellectual brilliance, Fernando values an unflagging commitment to one's profession. The "father of Philippine diabetology"--a title he's not comfortable with and, he says, others aren't either--tries to inculcate the same drive and sense of social responsibilty in his students. "When we choose doctors in the institute, we don't necessarily choose the brightest. What we need are doctors who come from areas where there are no diabetologists or even internists, and who will swear that they will go back after two years of study," he explains. "The last thing I tell them when they go out is to go to the nearest government hospital. If they don't have a diabetes clinic, put up one even if you don't get paid."
It's a huge sacrifice, but in a country where practically everyone is related to someone who has diabetes, it may just be our saving grace.
DR. ERLINDA MARIA DE GUZMAN GORDON
For centuries, cancer has brought indescribable suffering to many and claimed the lives of millions. The race to find a cure has been marked by bursts of optimistic discoveries and series of halting failures, but the finish line has never been in sight, until now. Dr. Erlinda Maria de Guzman Gordon and her partner, Dr. Frederick Lewis Hall, have created what could possibly be the magic bullet that would kill cancer cells without causing any systemic side effects, such as those triggered by chemotherapy.
Gordon, a pediatric hematologist-oncologist working at the University of Southern California School of Medicine and the Children's Hospital of Los Angeles, has made great strides in cancer research and gene therapy studies. As a recipient of the United States National Institute of Health's Research Career Development Award, she has published many seminal papers, including one on the cancer drug VM26 used for the treatment of acute monoblastic leukemia in infants. But, undoubtedly, her most outstanding contribution to medicine is the cancer drug, Rexin-G ("Target Acquired," MEDICAL OBSERVER, October 2005). It might just even garner her and Hall the much-coveted Nobel Prize for Medicine.
The doctor's journey started with a plea from her dying bone-cancer patient to develop a cure for the disease. It was 1991, and science was just giving birth to gene therapy. Whether it was coincidence or fate, Gordon, in 1994, met Hall, a physiologist and biochemist who had just cloned a gene that was overexpressed in bone cancer, the cyclin G1 gene. Once its mutated version was created, they found out it would not only abort the tumor cells, it would also cut off its oxygen supply, effectively snuffing out the tumor's ability to survive.
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But that was just half of the battle. The key to ending the war, which has left many scientists baffled, was to design a targeted delivery system or the equivalent of a GPS (global-positioning system), as Gordon calls it, that will guide the missile--or the gene therapy vector--to the cancer sites. "It was serendipitous," she says of their discovery of the target motif, which has been there the whole time in nature. The hemotologist recalls in her studies that hemophiliacs suffering specifically from Von Willebrand disease bled even though they had normal amounts of blood platelets because they lacked the Von Willebrand's factor, which are "partners that guide the platelets" to the injured areas of the body.
"We found that there were certain motifs or peptide sequences (in the Von Willerbrand protein molecule) that we can cut out by molecular engineering. We cut it out and put it on the surface of the vector," she explains. The viral coat on the vector anchors the targeting motif, which leads the killer gene straight to the tumor cells, all of which share a pervasive property--their attack on any organ exposes the collagen found in the organ's connective tissues. The vector binds to the cancer cell and penetrates the tumor's newly formed, permeable blood vessels. It inserts itself into the chromosome of the tumor cell and alters the genetic message for cell division from "fifth gear to stop ... at a certain checkpoint of the cell cycle." If the vector enters a healthy cell, one that is not rapidly dividing, it is quiescent. It will die, get digested by the cell, and be eliminated.
Manufactured only by Gordon and Hall's company, Epeius Biotechnologies--aptly named after the maker of the Trojan horse which hid an army of soldiers--Rexin-G has shown a 100-percent efficacy among lab animals, an 83-percent tumor response--tumor shrinkage or disappearance--in pancreatic-cancer patients, and a 100-percent success rate in arresting tumor growth in humans, without exhibiting any dose-limiting toxicity. The results were gathered following the protoccol of assessing the patient's condition on the 28th and the 42nd day from start of treatment. Rexin-G is currently being tested at the Asian Hospital and Medical Center in Alabang, Mayo Clinic in Minnesota, and the Lutheran Medical Center in New York.
The two scientists would like to have it eventually available not only for pancreatic-cancer patients, but for anyone with solid tumors. With its safety profile, this technology has the potential to revolutionize cancer treatment, even as far as having patients administer the treatment themselves. Gordon sees a future when an individual, who may not need to be admitted to a hospital, can wear a pump that delivers the drug continuously. Rexin-G can also be a diagnostic tool for detecting cancer, when the appropriate imaging technology is applied. "It can cure heart disease, as well, or any damaged vessel," she adds.
For the dynamic duo, it isn't enough to eradicate the tumor; their goal is to cure. Enter their second most promising discovery, Reximmune-C, which is similar to Rexin-G except for the genetic payload. Taking the place of the killer gene is an immune response gene--a tumor antigen that works the same way measel and polio antigens do. It goes to the cancer cell and alerts the body's immune system to the presence of a foreign invader--the tumor cell--thus building up the antibody response. Once approved, the vaccination will be administered between sessions of Rexin-G treatments.
Although Epeius Biotechnologies is a small company with a staff of 12, it has plenty of projects in the pipeline, including a stem-cell technology that can be used for tissue regeneration and treatment of AIDS. But Gordon is currently focused on the clinical trials for cancer treatment, which has brought her shuttling every month between Los Angeles and Manila to help supervise the trials. Not long, the pediatrician and oncologist hopes, she can use it to heal children who are ravaged by the disease.
DR. AUGUSTO LITONJUA
When you're diagnosed with diabetes, it doesn't mean that you're condemned to be blind or amputated. You can fight that," declares Dr. Augusto D. Litonjua, eminent endocrinologist and staunch advocate of diabetes education in the country. Because of his work, many have been given confidence to lead fuller lives while battling diabetes and other metabolic disorders.
This soft-spoken doctor brims with equal enthusiasm as he outlines his activities for the day--making his usual patient rounds, preparing lectures, meetings, etc. Never missing a beat, he switches between the roles of a clinician and a teacher--not quite surprising for someone whose impressive credentials fill many pages.
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Litonjua has always been a tireless achiever, reaping honors in a steady stream since he was in school. Even World War II did not stop him from getting his own dose of "schooling," for during those chaotic times, he even managed to hone his painting and violin-playing skills. Later, encouraged by his doting parents, Augusto pursued a medical career and eventually trained in Boston, getting a fair amount of exposure in diabetes and thyroid clinics. Upon his return home, he was encouraged by Dr. Paulo Campos, then chair of medicine at the University of the Philippines-Philippine General Hospital, not to waste his training abroad. Thus, despite meeting resistance from older practitioners, Litonjua went on to establish endocrinology as a subspecialty of internal medicine. He practiced at major hospitals, taught at the UP College of Medicine, participated in research, and founded various medical societies. He also pushed for innovations in his field, such as highlighting the importance of postprandial blood sugar over fasting blood sugar.
"Now," he shares, "what I am fighting for is to have lipids extracted in the postprandial stage ... because postprandial lipidemia is one of the independent risk factors for heart disease."
In his long career, he considers his diabetes-awareness campaigns as his most notable achievement. These projects were churned out through the various organizations he founded. He also set up the Diabetes Center at Makati Medical Center; he deems it "the first of its kind in the country, if not in Southeast Asia." This center has helped empower both health-care workers and patients through regular seminars on diabetes. "I think there has been a better awareness of diabetes and what it stands for since five years ago," Litonjua says.
At 75, he does not show any signs of slowing down. He is still trying to cook up more improvements for the Diabetes Center and is busy preparing for the upcoming seminar of the revitalized ASEAN Diabetes Educators this December. "Of course, you do get tired. But then what do you do? Stay idle, then grow old and weaker?" he counters. "As long as I can do it, then why not do it?" Like insulin, which faithfully labors to normalize blood sugar, Litonjua stays busy as long as he needs to. Sheila Lynn Molarto
DR. ROLANDO HORTALEZA
He started a small backyard business manufacturing cuticle removing solutions, and built it into an empire that had big foreign global companies shaking in their boots. His name is Dr. Rolando B. Hortaleza, and the multibillion-peso home-grown giant is Splash Corporation, the only Filipino company to break into the tight circle of the ten largest players in the local personal-care industry.
His story--a classic rags-to-riches, David-versus-Goliath tale--began after he graduated from medical school in the
eighties. An enterprising fellow who had spent summers helping his family sell salon products, he decided he could start his own venture along the same lines, while pursuing his residency at a Tondo hospital. The earnings would hopefully augment his meager income, and provide his wife Rosalinda and the baby she was carrying a decent life.
With only PhP12,000, he stacked up an initial inventory of acetone, cold wave or perming lotion, recycled amber glass bottles that used to contain cough syrup, and other packaging materials, and bought the formula to a cuticle removing solution. Capital-wise, it set back the Hortalezas by PhP5,000, but it had given them their first taste of cosmetic chemistry, in more ways than one.
The formula, written in crude measurements that rely on tabo (water dipper), required endless hours of trial and error. To transfer the solution from large vats to bottles, Hortaleza used a medical rubber tubing as siphon, sometimes accidentally swallowing mouthfuls of the vile pink liquid. His wife, on the other hand, abandoned her medical career to hawk their wares from one shop to another. Suffice to say, it wasn't the easiest job in the world for a pregnant woman. But by the end of its first year, sales exceeded PhP100,000, which impelled Hortaleza to make a life-changing decision: he quit his residency in ophthalmology and went full time with the business.
The company's first big break happened in 1987, when Splash cashed in on the big-hair fashion trend, and became the first to manufacture a local hair spray at an unbelievably low price. It was later followed by the success of Extract facial cleanser, and, much later, Extraderm, a complete line of facial-care products that introduced Filipinas to a regimen that goes beyond soap and water.
Now, the company has not only penetrated other Asian and Middle Eastern markets, Hortaleza has also recently launched the Splash Pharmaceutical Corporation. First to roll out of the plant are a range of virgin-coconut-oil products and indigenous herbal medicines, like ginger capsules and banaba tea. Hortaleza attributes the company's "small level of success" to "managing relationships," a skill he honed from years of medical practice. He says, "You don't just learn the technical skills, but it's more the value of hard work and the ability to engage the patient or the client.… It's always about getting into the mind of the consumers and touching their hearts."
DR. NELIA MARAMBA
It was during the Japanese Occupation when Dr. Nelia Maramba, a staunch advocate of herbal medicine, was first awed by the healing powers of plants. When a doctor failed to relieve her sister from a severe case of edema and infection, Nelia's grandfather administered homemade remedies, based on a book handed down by his grandfather, a pharmacologist from China. He cultivated penicillum notatum on a piece of bread, applied it directly to the infected area of the leg, and six hours later, the abscess disappeared like "magic," to the delight of the five-year-old Nelia. To treat the edema, she and her family ground and boiled cogon roots. Her ailing sister drank the liquid tonic for five days, before she was completely healed.
Years later, astounded by the bloated cost of primary health care, Maramba proposed a scientific investigation into the efficacy of herbal treatments practiced by traditional healers, the arbularyo. The medical community reacted with scorn. A colleague even mockingly tied a handkerchief around her forehead in the manner worn by the lowly arbularyo. But she was unfazed. "Saan ba nanggaling yung aspirin? It's from the bark of the willow tree; it's salicylate. Codeine, for cough, is from
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poppy plant," she reasoned. Together with some doctors, she went ahead and formed the National Integrated Research Program on Medicinal Plants. They scoured the country for herbs and compiled their findings--more than 3,000 plants and their uses--in a CD, providing an invaluable source of reference. For 10 years, they tested 85 plants, found out which are safe and efficacious, and published a guide to the 10 best medicinal plants for everyday life. These efforts have awakened the public and the medical community to alternative forms of healing, which proves that medicine need not always be hard on the pocket.
Maramba is leaving another indelible mark, this time in the field of toxicology. After establishing the poison-control center in the Medical College of Georgia while she was the chief resident in pediatrics, she came home, found out how ill equipped the country was in handling poisoned patients, and decided to put up a similar but nationwide center. She started a database correlating blood levels with toxidrome, and cofounded the Philippine Society of Clinical and Occupational Toxicology. With fellow physicians, she taught medical practitioners how to treat organophosphate poisoning, which killed three out of 10 victims, and set up the first set of guidelines for the management of pesticide poisoning. Now, the mortality rate for the commonly used substance has dropped to less than one percent. Maramba also successfully lobbied the Department of Agriculture for the creation of the Fertilizer and Pesticide Authority that ensures pesticides are safe for both the user and the environment.
Her crusade against environmental poisoning has brought her to places like Marinduque, Clark, Marilao, Tagum, and Diwalwal, where mining, toxic spills, and hazardous waste-producing factories are slowly killing lives. Whether it was an entire school of children poisoned by lead and arsenic, or a community of miners exposed to mercury, Maramba and her team would not only perform the detoxification, they would set up a poison-management task force within the area, one that would be prepared to control similar health crises in the future. In any community evaluation they do for the Department of Heath, they always invite the DENR, the local government, nongoverment organizations, and private organizations to the discussion table, to make the community intervention work.
This year, the National Poison Control and Information Service-not recognized as unit but merely as a service--finally evolved into the National Poison Management and Control Center. Maramba's team of 11 multidisciplinary toxicologists--neuro, psychiatric, pediatric, environmental, and others--a rare setup even by European standards, has made great strides in establishing, promoting, and legitimizing clinical toxicology in the country, and saving thousands of lives. With her impressive track record, Maramba should probably be called the "mother of clinical toxicology in the Philippines."
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