Duque: Focus on safe delivery
Health secretary Francisco Duque iii urged perinatal-health workers to get behind the government's mission of reducing neonatal deaths by at least 75 percent.
Speaking at the 15th annual convention of the Perinatal Association of the Philippines in September, Duque noted an "unacceptably high" daily average of 10 mothers dying upon childbirth, especially in poor and underserved areas of the country. These deaths are mostly due to the same "tragedies that were already killing … women for so many decades: hemorrhages, hypertension, … infections, and complications of abortion."
He added: "In the Philippines, perhaps the most threatened human rights are the right to safe pregnancy and delivery of the mother and the right to a fair and healthy start of every child."
The Philippines' newborn mortality rate of 18 deaths per 1,000 live births also stands in stark contrast to the progress made by richer nations in reducing neonatal mortality to four out of 1,000 live births.
Duque said that these statistics exist in the context of past goals and efforts that have bogged down. Although the country signed various international agreements, many of the commitments the country has made are as yet unmet-as in the promise to halve maternal deaths by 2000.
The Department of Health (doh) now proposes to focus on strengthening obstetric care during delivery to save as many mothers and neonates as possible. He said: "Safe, professional care during delivery is the most inequitable component of our maternal and newborn program … and yet, this is where we have the greatest opportunity to save lives."
He added that two decades of experience with the safe-motherhood initiative across countries have shown that only essential obstetric care can effectively bring down maternal mortality, as opposed to prenatal care alone, since 80 percent of maternal deaths are due to complications not detected by prenatal screening.
The doh, he said, has laid out specific strategies to address the equity gap-which has to do with basic access-and the gap in the continuum of care. The latter has to do with integrating basic care with other priority interventions such as those for tuberculosis, malaria, hiv/aids and other sexually transmitted infections, women's reproductive health, and the promotion of breast-feeding.
The Philippine Health Insurance Corporation (phic) has been mandated to include safe-motherhood and newborn packages that will not only benefit the mothers and infants themselves, but also the health-care professionals who will implement the government's plans for maternal and neonatal care.
The doh is also promoting the creation of a robust network of accredited, low-cost birthing centers close to communities and run by midwives, which can provide efficient and high-quality referral care to the hospitals. By shifting births from homes to appropriate health facilities, the department hopes to significantly increase the number of births attended by skilled professionals.
Duque said that limited resources should not prevent the system from providing quality care. He cited the case of Sweden, which achieved a low neonatal death rate as early as the 1970s-even before the country had the luxury of high-tech facilities.
He highlighted the role of health professionals in the government's efforts, noting the massive investment needed in human capital, specifically for doctors and midwives. M Grace Roxas
Pda stages Diabetes Expo
In celebration of 2006 World Diabetes Day, the Philippine Diabetes Association (pda) held the Diabetes Expo November last year at the SM Megatrade Hall. Fifty-eight exhibitors representing medical societies, pharmaceutical companies, manufacturers of consumer goods, and hospitals took part. The two-day exhibition also featured lectures by physicians, belly dancing, cooking demonstrations, and free blood-sugar screening.
Calling attention to the escalating problem of diabetes in the country, Dr. Ma. Teresa Que, pda president, said diabetes should not be simply dismissed as "a touch of sugar," but the hidden epidemic of the 21st century. She noted that the number of diabetics is increasing, with about six million people developing diabetes every year worldwide. Already more than 230 million people are afflicted by diabetes.
Saying that lifestyle-related diseases like diabetes choose not their victims, Health secretary Francisco Duque iii stressed prevention as the single most effective means of dealing with the problem. Lifestyle change is the key, said Colin Sindall of the World Health Organization. For his part, actor Dingdong Dantes, pda spokesperson for its youth program, has this message for the youth: Don't smoke, eat right, exercise, watch your weight, and relax.
The pda is among the organizations led by the International Diabetes Federation that supported the landmark United Nations resolution on diabetes passed in December. The resolution is seen as a tool in raising awareness among policy-makers of the global public-health challenge diabetes poses, said Dr. Tommy Ty-Willing, pda vice president, stressing the need for various sectors to unite in the battle against diabetes. M Isabelle Yujuico
Learning from the dead
Autopsy, whether for medical or legal reasons, is often shunned by Filipinos. Despite the value of the procedure as a tool for medicine and an instrument of justice, autopsy rates in the Philippines-already low to begin with-continue to go down even more, according to the country's only forensic pathologists.
Drs. Raquel Fortun and Ma. Cecilia Lim were guests at the recent Health Forum of the Philippine College of Physicians (pcp). They were joined by Dr. Nelson Geraldino, president of the Philippine Society of Pathologists (psp). All three are faculty members of the University of the Philippines department of pathology. Fortun and Lim direct the autopsy services at the Philippine General Hospital.
There are two main categories of autopsy: hospital (or medical) and forensic.
Hospital autopsies, as the name implies, are performed on patients who die at a hospital, of natural (i.e., medical) causes, with no particular legal concerns. These autopsies, said Lim, identify any possible hereditary or infectious diseases the patient may have had that may have an impact on living relatives or even on the community.
While the hospital autopsy provides some relatives with "closure," allowing them to accept the ultimate fact of the death of their loved one, others object to it because they feel the procedure is not "respectful" of the deceased, that the procedure reduces the human body to a mere object to be studied and examined.
"Pag-aaralan nyo lang naman yan eh," Lim quoted a common objection made by relatives who refuse to have autopsies done on deceased family members. "Parang masama na may matutunan kami sa pagkamatay ng isang tao; pero yung matututunan mo sa patay, nakakatulong sa buhay."
Hospital autopsies serve to identify undetected, and even new, previously unknown diseases, and may even help develop therapeutic strategies by showing whether a particular drug had been working or not prior to a patient's demise.
Another benefit from the autopsy, added Fortun, is to help deliver justice. Forensic autopsies deal with deaths that have legal issues or concerns, particularly those that result from violence, otherwise suspicious circumstances, and mass disasters.
Forensic autopsy helps ascertain the identity of the deceased, determine the cause and mode of death (natural or unnatural, if unnatural whether suicide, homicide, accidental, or undetermined), and to provide evidence in legal proceedings. M C. Samaniego, MD
Ortho surgeons told to effect change
We are essentially no different from each other," said House minority leader Francis Escudero. "Our country is no different perhaps from the patients that come to your respective clinics and offices. Our country is made up of broken bones and perhaps even shattered bones."
Keynoting the 57th annual convention of the Philippine Orthopaedic Association (poa), Escudero talked about the role of doctors in "healing" the nation. "Our basic objective is simply to rebuild, reconstruct, and hope to make whole what was once broken.... We seek to effect change however how big or small it may be in our chosen field."
Escudero said that age should not be a problem for people who really want to make a change. Noting the presence of a significant number of young doctors in the audience, he said: "Being young at heart or being at age should never be seen as a hindrance in so far as performing what you can is concerned."
The convention served to update its attendees on the latest in the practice of orthopedics. Dr. Winston Estera, poa president, delivered the welcome address, while immediate past president Dr. Miles de la Rosa was cited for "a job well done" during his term as president.
The event carried the theme Strengthening the Orthopaedic Subspecialities. It ran from November 21 to 24, and featured 10 major sessions and expert speakers from here and abroad. Also, representatives from other Asian orthopedic societies attended the event.
The ribbon-cutting of the Trade and Scientific Exhibits was led by Philippine Medical Association (pma) president Dr. Jose Sabili, together with Escudero and Estera. The first day was capped with a Fellowship Night, where new poa fellows were also inducted.
Among the highlights of the four-day meet were discussions on giant-cell tumors, the foot and ankle, hand and microvascular sugery, practical tips in spine surgery, hip and knee arthroplasty in young patients, shoulder impingement, lower-limb deformities in children, sports medicine, and the management of open fractures and polytrauma patients. M Isabelle Yujuico
United front versus hepatitis B
Representatives from various sectors of society joined together on January 23 at the Mandarin Hotel to pledge allegiance against the silent epidemic-hepatitis B.
Hepatitis B is a global health problem affecting as many as two billion people. Of this number, 300 to 400 million people have chronic liver disease, resulting in a million deaths yearly. Asia accounts for half of the total global mortality and 45 percent of total global disease. In the Philippines, an alarming 16 percent of the population is estimated to have chronic hepatitis B.
Said Dr. Erlinda Valdellon, president of the Hepatology Society of the Philippines (hsp): "If we put our population roughly at 80 million, we have among us 12.8 million Filipinos who have chronic hepatitis B, and most of them do not even know that they are affected. Without appropriate management and monitoring, one in four of these hepatitis-B chronic carriers will eventually die of liver failure or liver cancer."
The Third Hepatitis B Summit slated February 22 hopes to contribute to halting this trend by bringing together the country's formidable experts in the fields of gastroenterology and infectious diseases to provide updated information about hepatitis B as part of an advocacy, and to build awareness not only among patients but within the medical community as well.
It is organized by the Philippine Society of Gastroenterology, hsp, Philippine Foundation for Vaccination, Philippine Obstetrical and Gynecological Society (pogs), Philippine Association for the Study of Liver Diseases (pasld), Philippine College of Occupational Medicine, and Private Schools Health Officers Association. It is held in cooperation with the World Health Organization (who) and the Department of Health (doh), with the support of GlaxoSmithKline and Medical Observer.
Various sectors of the community are doing grassroots work in fighting hepatitis B by actively promoting newborn vaccination. Giving the hepatitis-B vaccine at birth will benefit every Filipino, said Dr. Lulu Bravo, executive director of the University of the Philippines-National Institutes of Health. "It is the only way to prevent the transmission of hepatitis B from the mother to the baby," she said.
Dr. Christia Padolina of the pogs agreed: "I think this is one of the thrusts, one of the strategies that we need to implement in order to catch them early and prevent the disease from progressing."
The World Health Organization (who) has a regional goal of reducing the number of children affected at birth to below one percent. Dr. Jean-Marc Olivé, who representative to the Philippines, is eager to achieve this in the Philippines, but he cautioned: "This is a big challenge in the Philippines knowing that not even 50 percent of the births occur in a medical institution. The majority of births in the Philippines are still at home so you need to devise innovative strategy to try to reach those most at risk, to make sure that they receive the vaccine within 24 hours. That's not an easy task."
The doh, for its part, is actively campaigning for legislative and administrative measures. One of the strategies, said Dr. Lyndon Lee Suy, is the issuance of an administrative order making hepatitis-B immunization mandatory at birth.
In addition, the Philippine Health Insurance Corporation (philhealth) will include the at-birth dose of the hepatitis-vaccine in its newborn package starting this year.
Vaccination at birth is more effective than adult immunization, explained Dr. Jose Sollano, immediate past president of apasl. "If you are vaccinated when you are young, the effect of the vaccine is very high and you are protected--almost 100 percent if you get three injections," he noted.
To further bolster the commitment of the various stakeholders to fighting this epidemic, the Third Hepatitis B Summit will be held on February 22 at the New World Hotel in Makati City. M Carisa Paraz, MD
Joint convention on digestive health
The Philippine Society of Gastroenterology, Philippine Society of Digestive Endoscopy, and the Hepatology Society of the Philippines celebrate Philippine Digestive Health Week by holding a joint annual convention on March 12 to 14 at the Edsa Shangri-la Manila Hotel.
This year's convention marks a milestone, as, for the first time, the three societies join hands in updating medical practitioners on recent developments covering the study of the alimentary tract, liver diseases (specifically nonalcoholic fatty liver), biliary-tract diseases, gallstones, liver cirrhosis, functional gastrointestinal disorders, gastrointestinal malignancy, hepatitis B and C, and endoscopy training.
Dr. Ernesto Que, psg president, said that the convention has a comprehensive scientific program designed to update both generalists and specialists, including a postgraduate course, simultaneous clinical symposiums, plenary sessions, and free-paper presentations. An endoscopy workshop has also been designed to update endoscopy nurses, trainees, and endoscopists on recent advances in gastrointestinal endoscopy.
The joint annual convention is made possible with the support of AstraZeneca, GlaxoSmithKline, Novartis, Otsuka, Westmont, Pharmalink, Sanofi-Aventis, Altana, Blooming Fields, Hi-Eisai, getz Pharma, and Boie Takeda.
For more information, please call the psg secretariat at 63-2-928-7014 or 63-2-928-3768 or visit the psg web site (www.psgastro.org). M
Lay forum on digestive disease
In celebration of the First Philippine Digestive Health Week from March 11 to 14, the Philippine Society of Gastroenterology (psg), Philippine Society of Digestive Endoscopy (psde) and Hepatology Society of the Philippines (hsp) will hold the First Gastroenterology Lay Forum on March 11, at the Megatrade Hall 1, SM Megamall. Admission is free. Gates are open to the public from 10 a.m. to 9 p.m.
Dubbed as Tyan-katutak na Istorya: Talakayan Patungkol sa Atay, Sikmura, at Bituka, the event aims to raise public awareness on various digestive diseases, their prevention, diagnosis, and treatment. It also intends to correct myths and misconceptions that have been so prevalent among Filipinos and hopes to empower the public in making wise decisions about their health.
According to Dr. Jaime G. Ignacio, overall organizing chair of the Philippine Digestive Health Week, "the lay forum is our way of expanding social consciousness where we can directly educate the masses about certain issues concerning their health."
The event will feature open lay lectures with question-and-answer sessions facilitated by certified gastroenterologists. Speakers will discuss liver diseases (hepatitis A,B, C and others; fatty liver, alcoholic liver disease, and liver cancer), colon cancer (particularly its prevention), intestinal-motility disorders (diarrhea and constipation), nutrition and nutritional diseases, and acid-related diseases (acid-reflux disease, peptic ulcer, and dyspepsia) with the help of audiovisual presentations.
Information materials will also be handed out to the participants. Another highlight in the lay forum is the exhibition booths on digestive health by pharmaceutical and consumer-health-care companies.
Among the companies extending support to the event are AstraZeneca, GlaxoSmithKline, Janssen Pharmaceutica, Novartis, Otsuka Philippines, Westmont Pharmaceuticals, Pharmalink, and Sanofi-Aventis. Altana, Blooming Fields, Hi-Eisai, getz Pharma, and Takeda are also participating in the forum.
Marking a milestone in the pdhw 2007 is the joint annual convention, which for the first time invoves the three societies-psg, psde, and the newly formed hsp. To be held at the Edsa Shangri-la Hotel from March 12 to 14, the convention is open to all interested medical practitioners.
Other activities include the mini-lay forum to be conducted by gastroenterologists from the East Avenue Medical Center and the Veterans Memorial Medical Center on March 15 to 16.
For more information, you may contact the psg Secretariat at +63-2-9287014, +63-2-9283768 or visit the psg website at www.psgastro.org. M
Ipd vaccination will cut child deaths
Saying pneumococcal disease is the leading preventable cause of death in children under five years old, Dr. Lulu Bravo, director of the University of the Philippines-National Institutes of Health (up-nih), made a solid pitch for its prevention through vaccination
"Ipd (invasive pneumococcal disease, which includes meningitis) is an important vaccine-preventable disease globally," said Bravo in a lecture on pneumococcal diseases at the ninth Asian and Oceanian Congress of Child Neurology (aoccn) held January 24 to 27 at the Waterfront Hotel in Cebu City. The symposium was organized in cooperation with Wyeth Philippines.
Streptococcal pneumonia causes about half of ipd cases, with the rest being caused by other pathogens such as Haemophilus influenzae type B (Hib), respiratory syncytial virus (rsv), flu, Staphylococcus, and Klebsiella.
Worldwide, streptococcal pneumonia kills two million children a year, Bravo noted, citing data from the World Health Organization. Nearly half of these deaths involve children under five.
In the Philippines, Bravo said, about 9,000 children die of pneumonia every year. Among those under five, the mortality rate from pneumonia is placed at 37 per 100,000 population.
In making a case for vaccination, Bravo cited the decline in ipd incidence trends in countries where ipd immunization has been made part of the national immunization program. She noted that the development of pneomococcal vaccines and their inclusion into national immunization programs are among the top priorities of the who. "Pneumococcal disease is a major public-health burden with increasing antibiotic resistance…. And the impact of universal vaccination is not just in immunized children, but also in the broader community," she stressed.
She noted that conjugate pneumococcal vaccines are more efficient than polyvalent polysaccharide vaccine based on results of studies on safety, immunogenicity, and efficacy.
The aoccn provides a venue for pediatric neurologists to share their expertise with one another, "[enhancing] the quality of neurological care for children in the region." The first aoccn was held in Taipei, Taiwan, in 1983, and has since been held in various Asia-Pacific nations.
This year's theme, Building Bridges in the Practice of Child Neurology, underlines the group's important objective, "not only among the different member nations of this region, but also among the different medical and paramedical disciplines that are involved in the care of children with neurological problems," explained Dr. Aida Salonga, president of the ninth aoccn. M Russell Cruz, MD
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