A "POISONOUS" YEAR
The top health stories of 2006-from the Guimaras oil spill to the toxic wastes dumped into Marilao River
By Mike Gomez, Contributing Editor
The year 2006 was relatively uneventful-as far as health and medical issues in the Philippines are concerned. The country remained free from killer epidemics like SARS or the avian, flu and did not experience the much-feared explosion of AIDS predicted year after year. In fact, the only health-related event that could be considered natural or cosmic was the typhoon Milenyo that plunged millions into darkness and lowered Kris Aquino's popularity in October when dozens of outdoor advertising billboards were blown over or ordered removed. Most of the major health events that made the headlines in 2006 were caused by humans, whether due to negligence, politics, economics, or cultural factors. MEDICAL OBSERVER wraps up the year with a quick look at the most significant health issues that made headlines and provided fodder for discussion over the airwaves.
Worst oil spill ever
When the oil tanker MT Solar I sank half a kilometer to the bottom of the Guimaras Strait on August 11, the Philippines was faced with a disaster it was not prepared for. The half a million gallons of bunker oil spilling out of the tanker hired by Petron Corporation caused untold damage to one of the most celebrated marine biodiversity sites in the world-the Visayas Sea. It also compromised the health of thousands of coastal dwellers who suffered from the ill effects wrought by the vapors or fumes from the bunker oil that inevitably lapped over the shorelines, reefs, and mangroves, and accumulated as gooey sludge on the beaches.
While the economic impact of this disaster remains difficult to fathom, the acute health problems it inflicted had to be addressed immediately by local officials and the Department of Health. As hundreds of people sought treatment after inhaling aromatic hydrocarbons, the DOH and the UP National Poison Management and Control Center found that the level of hydrogen sulfide in the air in affected areas greatly exceeded the United States Environmental Protection Agency Provisional Remediation Goal.
The DOH-UP team also monitored the ambient air for benzene, ethylbenzene, toluene and xylene, as well as the drinking water, surface water, soil, and marine crustaceans for polyaromatic hydrocarbons and metals (lead, nickel and arsenic) particularly in areas where Petron was believed to have employed chemical dispersants to manage the spill. Government-hired workers tasked with cleaning up the sticky residue on the shorelines wore protective equipment to safeguard their health from the toxic chemicals and vapors.
Too many sepsis deaths
An unacceptably high number of neonatal sepsis deaths among babies born on a single day at the government-run Rizal Medical Center raised public alarm, and spurred investigations into the incident and hospital procedures as a whole. Nine of the 28 babies born at the hospital on October 4 died a few days later, indicating cases of early-onset sepsis. A fact-finding committee convened by the DOH, along with the National Epidemiology Center, determined that the cases were the result of mother-to-child transmission occurring even before the delivery.
The pronouncement drew the ire of various groups, including the mothers themselves, who accused the DOH of cover-up. In the spirit of command responsibility, however, the hospital's top officials went on indefinite leave while cases were being filed by the aggrieved parties goaded on by the local government and health-activist groups.
Dissatisfied with the pronouncements of the investigation panel, the mothers were also encouraged by activist groups to file charges against the investigators themselves, accusing them of violating the Anti-Graft and Corrupt Practices Act for clearing the hospital officials of liability. Health secretary Francisco Duque III headed the list of respondents in the cases filed with the Ombudsman. The health chief believes the charges against him were impelled by the political agenda of a party-list group that was exploiting the aggrieved mothers for their own ends.
Gloria's state of health
Easily, the politically explosive health story of the year concerned no less than President Gloria Arroyo who checked into St. Luke's Medical Center three times in a span of five months. She was first confined on June 22 following a bout of diarrhea that her attending physicians said was due to a viral infection aggravated by stress. On July 27, she was again rushed to the hospital because of "intestinal flu." Her third hospital trip on November 25 was officially announced as "routine executive checkup." Her attending physician, liver specialist Juliet Gopez-Cervantes, said Aroyo underwent a battery of tests, "a thorough checkup from head to toe," including surveillance endoscopy and colonoscopy.
Arroyo's three hospital trips fueled political speculation on her real state of health. Opposition leaders, heads of people's organizations, and political columnists called for complete disclosure because of rumors that she might be suffering from a liver problem.
Medical tourism on the go
Launched at the end of 2005, the Arroyo administration's newest economic strategy for addressing problems in the medical profession went into high gear this year with the country's first Medical Tourism Congress and Exposition, which showcased the best that the Philippine health-care sector has to offer and highlighted the promise of what is still to come. Aside from its still-to-be-tapped foriegn-exchange-earning potential, medical tourism is now also viewed by Malacanang as one of the solutions to the "brain drain" afflicting the health-care sector. Apart from dangling an exciting five-year income-tax holiday for health-care institutions that come on board the Philippine Medical Tourism Program, the government is also ploughing in millions of pesos into facilities development, hoping to cash in on the estimated $1.3-billion-a-year market.
The Philippines has long been regarded as an ideal destination for medical procedures like joint replacement, coronary-artery-bypass surgery, organ transplantation, and elective procedures ranging from laser eye surgery to cosmetic surgery. Currently, only St. Luke's Medical Center has been accredited by the Joint Commission International, making it the only full-fledged medical-tourism partner hospital of the government. Health undersecretary Jade del Mundo said that the program will benefit not only the health-care sector, but also the many downstream industries such as hotels, restaurants, shops, and transportation.
Dengue on the wrong side of the tracks
Public health officials often point out the predictability of dengue peaks, which usually follow a three-year cycle. Over the past several years, though, this pattern has become blurred by the many outbreaks and developments in case finding and management that dengue advisories seem to be necessary every year. It is not unusual for a number of dengue deaths to occur each year, but it seemed unforgivable when such losses occurred in an urban-poor relocation site set up by Vice President and Housing and Urban Development Coordinating Council chair Noli de Castro in Southville, Cabuyao, Laguna. Beneficiaries of this housing project are families evicted from their former squatter shanties along the railways in Makati, Manila, and Cabuyao, who had to be relocated to make way for the Philippine National Railway's Northrail-Southrail Linkage.
Outbreak investigations traced the problem to a high concentration of disease-vector mosquitoes breeding merrily in the drums used to hold water-a practice necessitated by the inadequate water supply in the resettlement area. In light of this, the Urban Poor Associates, a housing-rights advocacy group, pinned the blame for the six deaths and many other cases on the DOH and the National Housing Authority.
The business of kidneys
Several years ago, reports about the organ-donation "industry" in the Philippines horrified the world. But the country quickly became a popular source for transplantable organs because of the relatively high level of sophistication of our hospitals and medical facilities, which are well-equipped for both harvest and transplantation surgery, and the large number of impoverished people who would be only too glad to sell one of their kidneys to patients in need of a graft. In fact, this enterprise was attracting foreign patients to the Philippines long before medical tourism was conceived as a government program.
Now that medical tourism a priority government program, the sensitive issue of trafficking kidneys from "commercial" donors demands government attention. As underground organ sourcing was viewed as exploitative of the donor, who collects between PhP30,000 and PhPP50,000 a kidney vis-à-vis the PhP150,000 the organ broker earns from the deal, government wants to step in and regulate the "industry." The Kidney Foundation of the Philippines offers "gratuities" to living organ donors, using funds raised from donations given by transplant recipients to the foundation.
On the medical-tourism side, a business enterprise called "Concierge" aims to generate funds for Filipino organ donors and transplant patients from the foreign patients who come to the Philippines for such procedures. The country's top medical centers seem interested. Kidney transplants in most developed countries are largely sourced from deceased donors whose organs are still viable for grafting during a certain window after death or while a brain-dead patient is sustained only by artificial life support. Because of cultural barriers and the hesitation among many Filipinos to execute an organ-donor card, most transplantable kidneys in the Philippines are still sourced from living donors.
Pfizer's parallel importation woes
When the Philippine International Trading Corporation (PITC) and the Department of Health first ventured into the parallel importation of medicines several years ago, the government knew too well that it was impossible to import enough to make a dent in the market. The whole idea was to exert downward pressure on drug prices by distributing a small number of essential drugs at rock-bottom prices. This meant, of course, sourcing from India and Pakistan.
As the active ingredients used in the Indian imports were identical and the products were subjected to the harshest scrutiny by the Bureau of Food and Drugs, quality and efficacy were not contentious issues. What did become irritants were the issue of authorized distributorship, intellectual-property rights (IPR), and patents.
This year, PITC transacted a parallel import of Pfizer's popular antihypertensive amlodipine besylate (Norvasc) many months before the June 2007 expiry of the product's patent, purportedly to expedite regulatory approval. The product, however, appeared in PITC outlets and was apparently sold to the public. Pfizer objected to this alleged violation of international IPR policies and "infringement" of its patent. It sued the PITC and BFAD, and reminded the public that the company's ability to "continue the innovation cycle" of developing breakthrough pharmaceutical products depends on the protection of its intellectual property, as in the case of Norvasc. Health policy makers exploring pharmacoeconomic issues on the macro level have often pointed out that Filipinos suffer from a "double whammy"-having lesser disposable income for health-care and paying much more for medicines than those in developed countries.
Red tide in the City of Springs
The Interagency Committee for Environmental Health has tagged a number of bay areas in various parts of the country as permanent red-tide areas where harvesting of shellfish is prohibited year-round. Some other marine sites, such as the Cavite coast of Manila Bay, are constantly monitored by teams of the Bureau of Fisheries and Aquatic Resources who conduct plankton sampling and test for the presence of the deadly saxitoxin. So, it was baffling that in early November, a man and two of his children suffered fatal bouts of paralytic shellfish poisoning after eating mussels in far-away Los Ba?os, Laguna, even while the shellfish in Manila Bay were found to be safe.
Paralytic shellfish poisoning is caused by saxitoxin produced by marine dinoflagellates which, when proliferating to the point of causing "red tides" in the sea, is ingested in large amounts by shellfish and other marine organisms, making them dangerous for humans to eat. Blood samples from victims, including those who survived the poisoning, confirmed the presence of saxitoxin, as did a test of the mussel broth that the family ate. Evidently, the mussels did not come from Manila Bay, but were harvested by some unscrupulous fisherfolk who defied the government ban in the affected areas.
Scattering toxic chemicals
As if the forces of nature weren't deadly enough, other poisoning cases occurred during the year because of carelessness and indifference to health and safety. The San Isidro School in Makati had to suspend classes in the last week of November after an accident in its chemistry laboratory resulted in the inadvertent mixture of chemicals that produced noxious vapors of undeterminable composition.
In the same week, residents of Barangays Sta. Rosa and Lambakin in Marilao, Bulacan woke up in the early hours of the morning to the offensive odors of toxic waste that had been surreptitiously dumped into Marilao River while the town slept. As the noxious fumes caused some people to suffer dizziness, chest pain, nausea, headache, vomiting, difficulty breathing, and loss of consciousness, local officials ordered a systematic evacuation of the area. The driver of the truck who dumped the toxic waste pointed the finger of blame to a plastics-manufacturing plant in Valenzuela that produced the waste and the truck owner.
Down south, in Davao City, 79 people from the nearby town Braulio Dujali in Davao del Norte, many of them schoolchildren were brought to the hospital after being poisoned by chemicals released in the aerial spraying of an adjacent banana plantation. The crops had been sprayed with a nematicide containing ethotrop, a cholinesterase inhibitor that could severely affect the function of the nervous system. While the implicated company apologized for the glitch and made the proper reparations, the authorities continued to agonize over the long-running debate on whether or not aerial spraying should be permitted in the many plantations in that part of Mindanao.
Lumads downed by cholera
With the dearth of sanitary amenities in far-away locales in the Philippines, health authorities always expect cases of enteric diseases among cultural communities. A typhoid outbreak downed 500 persons and caused one death in Bunawan, Agusan del Sur, which is the gateway to the sprawling Agusan Marsh, the catch basin of the very wet Northern Mindanao provinces. Further out, however, 11 persons died from cholera in Kamalangan, Tamiang, Malitado, and Guinsawan of Barangay Binicalan, in the river town of San Luis, Agusan del Sur. The cases all involved lumads of the Banwaon tribe.
The remoteness of their location made confirmatory tests difficult since it takes over a day's walk to bring a stool sample or smear to an appropriately equipped laboratory. The severity of the outbreak, however, led epidemiologists to believe that the implicated pathogen was Vibrio cholerae. Sanitary inspectors suspected contaminated water sources as the cause of the outbreak since the residents of the four sitios draw their drinking water from shallow wells or from the river. National Epidemiology Center's Dr. Eric Tayag pointed out, however, that cultural factors such as burial practices should not be overlooked in such investigations.
Meningophobia
It was hard enough to pronounce "meningococcemia" correctly, but once people got the hang of it, it became a byword that the disease became the new bogeyman among an already panicky public. At the onset of the National Epidemiological Sentinel Surveillance Service almost two decades ago, meningococcal infection and meningococcemia were among the diseases that attending physicians at sentinel hospitals were required to report when cases are detected. Even as the disease occurs now and then, a recent incident involving a two-year-old girl brought to the Amang Rodriguez Medical Center in Marikina City caused widespread panic in the hospital. When word "leaked out" that the child who was consulting for high fever was a meningococcemia case, the entire hospital staff flew into a state of panic that took half an hour to manage.
The hospital chief took measures to contain any possible spread, which included sealing off the emergency room and entry points, fumigating the rooms, and distributing prophylactic medicines to all hospital personnel who came in contact with the patient. The child was transferred immediately to the San Lazaro Hospital, which is the referral center for infectious diseases for the National Capital Region.
Another child in Meycauayan, Bulacan was not as lucky. The one-year-old girl from Valenzuela was brought in with skin coloration and dark blotches characteristic of meningococcemia. The child contracted the infection after a three-week vacation with relatives in Barangay Bayugo in Meycauayan, Bulacan. The child died in the hospital before appropriate intervention could be given. Health authorities raised a disease alert in the town to avert any possible outbreak of what is now acknowledged as a "killer disease." M
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