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Sweets, Seeds, and Service: 15 Years of ISDF
A soft music wafts through the air, floating atop translucent wisps of smoke. Paces away from a nipa hut and a makeshift scarecrow, a farmer stood at the center of the gathering. With excitement in his eyes and a palpable eagerness in his movements, he surveys his field and smiles. Tonight marks the beginning of the harvest, the end of his labors, and with excited gestures, he beckons the audience to follow him. Only, the seed and the fruit were not of the agricultural variety at all. As he hangs his salakot the audience gets a glimpse of the logo of the country's-and the world's-only institute dedicated to the advanced study of diabetes.
The sequence opened the celebration of the 15th anniversary of the University of the East Ramon Magsaysay Memorial Medical Center-Institute for Studies on Diabetes Foundation (UERMMMC-ISDF), in tune with the theme "The Season of Harvest." The event coincided with the 75th birthday of its founder, acclaimed diabetes expert Dr. Ricardo Fernando. Officers, graduates, students, and their families graced the event at the banquet hall of the Wack Wack Country Club in Greenhills.
Heeding their mentor's call, "go ye unto all the corners of the nation and share what you have learned among our people who most need it," diabetologists-diplomats of internal medicine who underwent further training in diabetes-practiced their art in different areas of the archipelago, sufficiently representing the institute and its services to the various provinces of the Philippines. In a homecoming of sorts, the physicians have all arrived at the celebration elated at the abundance of their alma mater's harvest.
The UERMMMC-ISDF first accepted students for postgraduate studies in diabetes mellitus in 1989. Currently, more than five batches of graduates comprise a privileged group of experts in the field. In the intervening years, ISDF launched radio (1082 DZEC "Diabetes on the Air") and television (RPN 9 "Helpline
sa 9") programs to educate the masses on the now endemic metabolic disease. It also established diabetes control and prevention programs, as well as workshops for internists and other allied medical professionals, published educational materials for laypersons, and launched several diabetes care and foot care/wound management clinics.
The ISDF spearheaded the formation of, among other organizations, the ISDF Alumni Association (ISDF-AA), the Philippine Society of Diabetologists (PSD), the Philippine Association of Diabetes Educators, the Association of Diabetes Nurse Educators of the Philippines, the Consortium of Government Diabetes Clinics, and the Rainbow Camp.
Deeply entrenched in the minds of its members and the philosophies of its subsidiary organizations are the words of the ISDF vision: "… the delivery of quality diabetes care through education, service and research; the professional advancement of health-care providers; the prevention and control of diabetes; and the uplift of the lives of diabetic patients, their families and communities."
During the night's festivities, new officers of the ISDF-AA and the PSD were inducted. ISDF founding ISDF-AA president Dr. Rino Sobrepeña and former PSD president Dr. Marcelo Lim presented the achievements of these two ISDF auxiliaries.
Continuing medical education, the institutionalization of ties with the ISDF (including raising funds for the future ISDF building in Marikina), and the strengthening of alumni relations (celebrating annual alumni fellowship nights and giving out presidential awards for outstanding service) marked the advancement of the "dedicated, competent, compassionate, and progressive" alumni of the ISDF over the years.
But "the saga of fighting diabetes," says alumni association president Dr. Elwyn Fernando, "is unending." The oldest son of the ISDF founder is confident the new alumni association leadership is up to the challenge of furthering the group's goals. Though the accomplishment of their plans (upgrading the working knowledge of physicians in diabetes, among others) will undoubtedly be no easy task, he believes that cooperation is the key. "Our fellowship will give us perseverance," he says. "Teamwork will always be necessary to control diabetes."
Quarterly diabetes forums on diverse diabetic complications, echo lectures by participants of international conferences, and the annual Dr. Ricardo Fernando Professorial lectures highlight the achievements of the PSD for over a decade. A repository of the country's most knowledgeable diabetes experts, the PSD has been at the forefront of promoting and updating knowledge in diabetology. Composed exclusively of individuals with extensive contributions to the practice of diabetes care in the Philippines, the organization hopes to serve the role of a catalyst in the advancement of diabetes management. PSD president Dr. Edith Dalisay emphasizes the need for updating physicians' knowledge on diabetes. "Education is a never ending process," she says. "We owe it to our patients and our mentors to pursue excellence in our fields."
With active arms from the PSD and the ISDF alumni association, a new building undergoing construction in Marikina, 250 diabetologists who underwent training from the institute now serving throughout the countryside, and the distinction of being the only institute of its kind in the world, the ISDF had all the reasons to celebrate.
Divine Providence has played a large part in the institute's success, says the elder Fernando. He adds that "if this thing were of man, it will not last … but [since] it [was] of God, it [prospered]." The charismatic founder of the ISDF, fondly called by friends as "pastor-doctor," often quoted a verse from the Bible (John 12:24) to sum up his accomplishments. "Unless a grain of wheat falls into the earth and dies, it remains alone. But if it dies, it bears much fruit."
C. Russel Cruz, MD
Treading on Faith and Passion
There is a remarkable ease in the manner Dr. Ricardo Fernando conveys his philosophy, a gratifying simplicity in the way he delivers his words and his ideas. The pioneer of studies on diabetes in the Philippines recently celebrated 75 years of a life dedicated to service, filled with accomplishments, characterized by passion, and devoted to faith.
"The fruits of joy and peace from this life," he says, "[are worth] much more than material things." Born from humble beginnings, the eminent diabetologist had more faith than financial resources early in his life. "The fear of the Lord," he says, "is the one gift my parents gave me which I consider most important. Faith, after all, is the thing that moves mountains."
The second child of a Methodist minister and a kindergarten teacher, Ricardo and his three brothers were all taught the value of education. The young Ricardo took to the academic life easily, and graduated valedictorian from secondary school.
"He was the brightest of the four of us," says older brother Rafael, himself a prominent businessman and a Johns Hopkins University alumnus. "Our parents instilled in us the value of studying for our future. We were poor, but we were educated."
Ricardo was offered a scholarship in a Wisconsin seminary, being primed for a life of preaching as a minister like his father. Upon arriving in the United States, he immediately demonstrated a remarkable aptitude for learning and intuitiveness, qualities that did not escape his mentors. He was advised to pursue a career in medicine, and with a scholarship at the University of the Philippines, he started off on a vocation he will spend the rest of his life loving.
It was while he was undergoing fellowship training in Boston that he first came to notice diabetes. His instructor in neurology brought the young doctor to the Joslin Clinic, seeking to give examples of diabetic neuropathy. Fernando was immediately fascinated by the disease and its intricacies-and knew this was the reason for his existence.
Several years later, the country bears witness to the numerous accomplishments of the father of Philippine diabetology. The Philippine Society of Diabetology owes its existence to his perseverance; hundreds of diabetologists owe their education to his philosophy; and thousands of diabetics all over the archipelago owe their rehabilitation to his brilliance.
Every undertaking he has dignified with his boundless energy is a testament to Filipino excellence and creativity. "Passionate" is a word often used by peers to describe the man. "He is passionate to the point of being a fanatic," quips Rafael. His definitive legacy, the ISDF, is something he intends to handle until the end.
"I want to follow this through," Fernando stresses. This passion, responsible for his achievements in the medical field, keeps his family life intact as well. "Every morning when we wake up," he says fondly, "my wife and I hold hands and thank God for our life, our joy, and our peace."
A man of service all his life, Fernando finds it unfortunate that an increasing number of young physicians seek material wealth over their noble vocation's dictates. "The fruits of joy and peace from a life [well lived] are worth much more than material things," he says. "We should measure the quality of our life by heaven's standard. We should, on our death, [realize what is important] is not what is left behind but what we can bring above."
He implored the physicians who celebrated with him that night, "We have a culture [of excellence and service] to share … heaven has been good to us, and we must respond accordingly."
C. Russell Cruz, MD
Gastro Specialists View Evidence-Based Options
Options in Clinical Gastroenterology: Eminence or Evidence-Based? was the focus of the joint annual convention of the Philippine Society of Gastroenterology (PSG) and the Philippine Society of Digestive Endoscopy (PSDE) held March 8 to 11 to, as scientific committee chair Dr. Melchor Chan put it, call attention to "the application of evidence-based medicine in the practice of clinical gastroenterology and hepatology."
In the opening ceremonies, the PSG and PSDE inducted new members and distributed Life Fellow Awards to members who have made significant contributions to the progress of the gastroenterology and digestive endoscopy subspecialties.
The ceremonies were followed by a three-part workshop on endoscopy led by PSDE president Dr. Evan Ong. Videos of interesting cases and techniques were shown to enhance the skills and clinical decision-making of PSDE and PSG members.
For the rest of the program, specialists provided pointers and tips on techniques in the management of common and complicated gastrointestinal problems. They focused on innovations and groundbreaking research, one of which is wireless endoscopy. They also tackled cost-effective screening techniques for colon cancer, preventing recurrence of colonic polyps, and the importance of preoperation radiotherapy for rectal adenoma.
Dr. Eulenia Nolasco, assistant professor at the University of the Philippines-Philippine General Hospital, delivered a lecture on logical and cost effective approaches in colon cancer screening.
Among Filipinos, colon and rectal cancers are the sixth and 11th leading type of cancer. Combined, they rank fourth, Nolasco noted.
Nolasco said screening would lead to early detection and removal of premalignant lesions that could stem development into full-blown cancer and improve prognosis. She lamented that only 30 percent of colorectal cancers are diagnosed at the stage when they are localized, stressing the need to detect them in them in the early stage.
Noting that colorectal cancer is relatively common and associated with high morbidity and mortality, Nolasco said it is readily detectable at a relatively benign and easily treatable stage.
Noted for his role in the development of nonsurgical therapy or microwave thermotherapy for bile duct carcinoma, Prof. Thierry Ponchon of the Hospital Herriot in Lyon, France delivered the Francisco Roman Memorial Lecture. He presented guidelines and standards in colonoscopy and discussed old and new methods, tools, medicines, and procedures used in countries like the United Kingdom, United States, Japan, and France.
Mariafe Pagsuguiron
PDA: Optimizing Treatment Strategies
Nutrition, endocrine dysfunction, and the impact of diabetes on nutrition and the health of women and children were but some of the major issues discussed in the recent annual convention of the Philippine Diabetes Association.
Among the speakers was Dr. Laura Trajano-Acampado who talked about the relationship of thyroid dysfunction and diabetes. She noted that development of diabetes "usually precedes the diagnosis of hypothyroid." She said thyroid disease is more prevalent in people with diabetes than in the general population. Hence she stressed the importance of making screening a routine for diabetic patients. "Yearly screening is likely to be of benefit for type 1 diabetics," she said
PDA president Rosa Allyn Sy talked of an emerging paradigm in obesity and diabetes risk involving portal, endocrine, and ectopic fat storage hypotheses. Ectopic fat hypothesis traces the cause of lipid stored in the wrong place to failure of new fat formation and impaired fat oxidation, she said.
Dr. Leilani Mercado-Asis, associate professor at the University of Sto. Tomas, discussed osteoporosis in diabetics, a disease that she said "is not a well acknowledged and often not considered." But she said some studies have shown a significant number of type 1 diabetics also have osteopenia at the time of diagnosis. As for type 2 diabetes, its relationship to osteopenia is not clear, she said.
Also, there is no consistent relationship between bone metabolism and diabetes mellitus. Asis explained that the decrease in bone formation is one of the major mechanisms of low bone mass. Microangiopathy, insulin, insulin-like growth factors 1 and 2, and cytokines have been tagged as contributing factors for diabetic osteopenia.
"There is a need for longitudinal studies to look at the incidence and risk factors for osteoporotic fractures because diabetes is already a debilitating disease with all its complications and osteoporotic fractures raise the cost of the disease," she said.
Miles Dumalagan
ADAP Presents Guidelines on Alzheimer's Disease
To celebrate its fourth anniversary, the Alzheimer's Disease Association of the Philippines (ADAP) conducted a public forum on Alzheimer's disease (AD).
The half-day event, held on March 12 at the Pan Pacific Hotel, featured the presentation of the latest draft of the ADAP recommendations on the diagnosis, prevention, and treatment of AD. The recommendations were a product of more than a year's worth of intensive research and deliberations, and were being presented to the public for the first time.
Dr. Socorro Martinez, ADAP president, talked about how, more than any other time, now is the best time to initiate programs dealing with AD. She cited that the above-60 population of the country has been steadily growing, and that by 2030, as many as 14.5 million Filipinos are at risk of succumbing to the disease. If the threat of AD goes unheeded, this would pose considerable burden to the health-care delivery system.
Dr. Mayvelyn Gose of the University of the Philippines-Philippine General Hospital talked about how the latest version of the recommendations was developed. She said that the team of people who had been directly involved in formulating the recommendations was divided into three technical working groups: one on diagnosis, another on the prevention, and yet another on the treatment of AD. Each team was composed of experts coming from different fields-neurology, psychiatry, geriatrics, and clinical psychology, to name a few. Meanwhile, Dr. Shelley dela Vega, also of the UP-PGH, detailed the long process of literature search, retrieval, and evaluation. Using the principles of evidence-based medicine, each team came up with recommendations based on the latest body of knowledge available. She said that the recommendations need to be reviewed and updated every two or three years.
Dr. Paulino Tenchavez of the Makati Medical Center discussed in detail the recommendations on the diagnosis of AD, while Dr. Miguel Ramos of the St. Luke's Medical Center presented the ADAP's recommendation on AD prevention.
The session on the treatment of AD was divided into three parts-one focused on the pharmacologic management of cognitive and global function impairment, with Martinez at the helm; psychiatrist Monina Cruz talked about the pharmacologic management of behavioral problems; lastly Dr. Doris Camagay discussed the non-pharmacologic component of AD management.
Each session was followed by a spirited open forum, which was participated in by medical and allied health professionals as well as representatives from other sectors of society.
Jin Paul de Guzman
Cancer Week Alerts Youth on Dangers of Smoking
Make the youth an advocate against smoking. This is what the Department of Health (DOH) intends to do as one of the means to enforce Republic Act 9211, the Antismoking Law that seeks, among others, to protect the youth from being initiated into cigarette smoking.
The DOH launched this reinvigorated campaign against smoking with the support of the Philippine Cancer Society, Department of Education, and multisectoral groups during the observance of National Cancer Consciousness Week on January 19 to 23. The celebration kicked off with a rally dubbed as Children's Rampage Against Smoking.
"The observance of the National Cancer Consciousness Week focused on tobacco should not end at making people aware of its hazards, but should make them realize that tobacco advertisements target the youth," Health secretary Manuel Dayrit said.
Dayrit added that tobacco companies lure children and young adults into smoking by associating tobacco with youth, beauty, fitness, success, and power. "How can smoking be linked to beauty and fitness when all it does is kill you and make you ugly," the health chief lamented.
In 2000 alone, 4.9 million out of the 1.3 billion smokers worldwide died prematurely because of smoking-related diseases. These figures are about evenly divided between the industrialized and developing countries.
Filipinos still do not know much about cancer and the hazards of smoking. Cancer ranks third among the country's top killer diseases. Statistics show that 55 Filipinos die everyday (20,000 a year) from lung cancer and other tobacco-related diseases. Experts say smoking and smoking-related diseases and deaths translate into PhP46 billion in annual cost of medical care and economic losses.
Lung cancer, primarily caused by smoking, is preventable. Understanding cancer and its root cause is one way to encourage people to develop healthier lifestyles and shun exposure to cancer risks. Maintaining a balanced diet high in fiber and low in fat, avoiding smoking, limiting alcohol intake, maintaining low body fat, doing self-examination, and getting regular check-ups are among the ways to prevent cancer.
To help raise the level of public awareness about the symptoms of cancer, the DOH and PCS have adopted a list of nine warning signs summed up as CAUTION US: Change in bowel or bladder habits. A sore that does not heal. Unusual bleeding or discharge. Thickening or lump in breast or elsewhere. Indigestion or difficulty in swallowing. Obvious change in wart or mole. Nagging cough or hoarseness. Unexplained anemia. Sudden weight loss.
Amzel Ordoñez
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