Farewell!

My final day in Manila!  2 months ago I was enjoying my honeymoon on the white sands of Boracay and it’s hard to believe that I’ll be hopping on a flight back home tonight.  Yesterday, I presented in front of my colleagues here at the Western Pacific Regional Office about my research this past summer, and it went very well!  The director of the Health Sector Development group and head of the Essential Medicines & Technology team attended, and there was a very lively discussion afterwards regarding the WHO and its future direction regarding R&D priority-setting (my team also surprised me with a birthday / farewell cake!  There appears to be a lot of celebrations that involve cake in this office…ironic for the World HEALTH Organization, eh?).  I will be presenting again this afternoon to my team in Geneva via videoconference and am excited to share the work that I’ve done this summer.

As I reflect on my experience this past summer, I feel very lucky to have had the opportunity to work with my team both in Manila and Geneva.  I hope that the work that I’ve completed is a step in the direction towards a healthier world, where diseases that affect some of the most vulnerable populations will someday soon have affordable solutions.  This experience was very valuable for my future career aspirations as well, and I am excited to see where my wife and I will end up next year after graduation.  Whether I end up in Manila, Geneva, the States, or who knows where, I am sure that the growth and experience from this past summer will help me along the way.

To the good people from the Women and Public Policy Program and the Cultural Bridge Fellowship, I would like to thank you again for your support and generosity.  My experience and the work I completed with the WHO would not have been possible without your help, and I am truly grateful.  I hope to meet some of you in the near future and share my research with you when I return to Boston. 

Signing off from Manila!

Sam

DOH Visit

This week I had a chance to visit some folks at the Philippines Department of Health, and I learned a great deal about all of the health-related action here in the Philippines.  I had the chance to speak with two people about both the reproductive health law and a new research priority-setting law.  I feel very fortunate to be in this country doing work related to many of these new exciting new changes!

First, I’ll talk about the issue that has all the attention here in the Philippines…the Reproductive Health Law.  As I spoke with a DOH staff member about the most recent news about the law, it was striking to see how similar it is to what is happening in the US regarding the Affordable Care Act.  Last year, the ACA was reviewed by the Supreme Court to determine the constitutionality of the law (it was passed).  Similarly, the Reproductive Health Law has hit a number of snags along the way and it is currently in the Philippines Supreme Court to determine if it is also constitutional.  Just like the ACA has divided much of the country over health care issues, the Reproductive Health Law has been a polarizing issue even within the DOH itself.  Had I worked at the DOH this summer, I would have likely worked on a supply chain project to evaluate how the government would deliver freely available contraceptives to its citizens.  Like many low to middle-income countries, last mile problems are all too common, but one could only imagine how much more difficult it is in the Philippines, a country composed of over 7,000 different islands!  Based on my conversation, I had the feeling that much like the ACA, there is still a ways to go before the law becomes effective.

I also had the chance to speak with someone who told me about the recent changes in health research priorities in the Philippines.  We had a very interesting conversation that helped inform my project, but what was most interesting was in regards to the creation of a National Health Research System.  This new system pools funds from various departments within the government to set and fund health research priorities in the Philippines.  Similarly, I was struck by how similar this is to the recent resolution that was passed at the World Health Assembly to hopefully use funds from different Member States to invest in R&D for neglected diseases.  The research I am conducting now will help determine how these funds will be invested.  Therefore, I am excited to hear more about how this new research initiative moves forward, as the WHO moves in a similar direction.

All in all, I had a great time at the DOH, and I am very thankful for chance to speak to the people who are closest to these new laws.  I have less than a week left here in the Philippines, and it is bittersweet to say the least.  My wife is leaving today, so it will be a boring weekend for me.  But it will give me time to prepare for my presentations early next week…wish me luck!

Office life...

It’s hard to believe that I’ve been in Manila for 7 weeks now and that my time here is almost coming to an end.  I am leaving in about a week and a half, and I am not ready to go!  My wife and I have had such an amazing time spending our first couple months of marriage experiencing life in a new country and traveling.  We are so extremely grateful for this opportunity and actually spoke the other day about potentially returning after graduation if things work out.  My wife studied international development at the Kennedy School, and we would like to work in a developing country after I graduate.  So again, this experience has been invaluable for us.

As I mentioned a few weeks ago, there are constantly conferences held at our office on a range of interesting topics.  From workshops on how to encourage smoke-free cities to expert panels on violence against women and children (which will unfortunately be held the week after I leave), there is always something going on here at the WHO Western Pacific Regional Office.  There is actually an interesting conference going on right now that I would like to attend; however, unfortunately, I am glued to my desk for the next week and a half, working on a final presentation that I will present to my colleagues here in the Western Pacific Regional Office and the rest of my team in Geneva (I did manage to sneak away for a few minutes to meet Conan O’Brien’s dad however, a Harvard professor attending the meeting).  The picture to the right is where I spend the large majority of my day.  The last time I spent this much time at a desk, I gained over 20 pounds!  So perhaps, it is a good that my internship is coming to an end soon :)

I do plan on venturing away from my desk next week to meet up with some folks at the Philippines Dept. of Health and am excited to hear about their work on the Reproductive Health Law, so stay tuned!  But for now, I am going to continue working on my presentation, and I look forward to sharing more about my work once I return to Boston.  Off to create more slides!

traffic...

There are 3 activities that take up the large majority of my time here in the Philippines: (1) sleeping (2) working and (3) sitting in traffic.  I thought I’d take a break from talking about health-related matters this week and blog about the far most unpleasant activity out of these 3.

Manila is NOTORIOUS for having some of the worst traffic in the world (ranked #3 worst city in the world according to CNNGo).  I’ve sat in some traffic jams here that make morning rush hour on the George Washington Bridge look like a trip down the street.  And if you’re one of the many unlucky ones who cannot find a cab in the rain, you better hope that you have a spare change of clothes and some extra cash for a potential stay at a hotel for the night (keep in mind it’s rainy season here).  In fact, when sitting in traffic for so long, it’s actually refreshing to have a cab driver that drives on the wrong side of the road at times to keep moving forward.  In case I haven’t painted a clear enough picture yet… traffic here is pretty bad…

I had a conversation with a one of the Filipina secretaries at work about her morning commute recently.  She told me that she has to take 5 jeepneys (jeepney: souped up jeep that serves as the primary method of public transportation in Manila) over the course of 1.5-2 hours to get to work on average (even 3 hours in the rain).  This doesn’t seem all that bad until I remembered that she’s been doing this same commute for over 30 years!  When I heard this, I was reminded of a recent article I read by Ricardo Hausmann.  In the article, he writes:

“In the typical developing-country city…Daily commute times for low-income formal-sector workers often exceed three hours, and the average direct cost of transportation is equivalent to roughly two hours of work at the minimum wage. An eight-hour shift becomes an 11-hour shift for which net pay is only six hours.  This implies an effective tax rate of 45% on low-income formal-sector workers.”

If you are interested, you can find the rest of the article at this website: http://www.project-syndicate.org/commentary/the-logic-of-the-informal-economy-by-ricardo-hausmann.  I’ll let Hausmann talk about the implications for better urban planning and policy.  As for me, I’m just hoping to find some readers who can commiserate with my traffic woes.  Until next time!

A seat at the table...

It was a very special week at the WHO Western-Pacific Regional Office.  Luck would have it that I am conducting research on R&D for neglected diseases in the same office hosting a meeting on the “Regional Action Plan for Neglected Tropical Diseases in the Western Pacific Region!”  I feel very lucky to have been able to sit in on the meeting, which hosted WHO program leaders from every country in the Western Pacific and representatives from various government agencies, NGOs, foundations, and private companies.  The guest list included people from the Gates Foundation, USAID, CDC, GlaxoSmithKline, Johnson & Johnson, and many more.

It was very interesting to see the faces of all the individuals, all of the different languages spoken, and all of the countries represented in the room.  Each individual sitting in the room had years of health-related experience and knowledge, and after spending an hour or two in the room, it was very clear that each individual had his/her own agenda.  The education NGO would frequently raise the importance of utilizing the education system to spread awareness, while the worms NGO would often speak about mass drug administration campaigns, and each country delegate had his/her own country-specific requests.  And as I realized this, I took a quick census of the room to see how many women were there, and I was very pleased to find that roughly half of the participants were women.  While this is not an indicator of the amount of attention that was paid to women’s health-related issues during discussions, it was reassuring to see that women had a seat at the table and had a voice at a meeting that could potentially benefit millions of women throughout the Western Pacific region.

I have often wondered what it would be like to sit at a large meeting at the World Health Organization, and I feel privileged to have finally experienced it.  Perhaps, one day I will be lucky enough to also have a seat at the table!

Late night trip to the ER

It was another eventful week in Manila, but unfortunately, it was a little scarier than I would have hoped.  There are a lot of scary things in Manila – being in rush hour traffic with cars that have no regard for traffic laws, getting stuck in torrential downpours during monsoon season, having potentially dengue-infected mosquitoes flying by your legs during the day.  However, there are few things that scare a new husband more than his wife getting sick in a developing country.  My wife had a small medical emergency and we had to go to the emergency room in the middle of the night.  Thankfully, everything is okay now due to the good folks at Makati Medical Center, but it definitely gave us a scare!

As we were sitting in the waiting room in the emergency department, I was reminded of the fact that I had an opportunity to work at Makati Medical this summer.  It appears as if I was destined to come to Manila!  It was a great opportunity that would have given me a chance to see the inner workings of a very successful hospital in a developing country, but it just wasn’t the right fit.  After researching a bit more, I discovered that Makati Medical Center is indeed one of the top hospitals in Manila.  Upon closer inspection, when one looks at the top 3 hospitals in Manila, they are all located in the most affluent areas of the city.  While I would have had the chance to see the high quality of care at one of the country’s most prestigious hospitals, it would ultimately be a summer providing services to the small percent of the city that could afford such high quality of care.  Not that there is anything wrong with providing quality care to these folks (like my wife), but I was looking for something else.  My hope is that the rest of the hospitals in Manila can someday attain the same level of care that Makati Medical Center provides.

“He who has health has hope.

He who has hope has everything.”

I’ve always liked this Arabian proverb, and it was something I kept in mind when I was choosing what I wanted to do this summer.  The work that I am doing now with the WHO focuses on individuals with some of the most neglected health conditions and often times without hope.  I hope that my work will contribute to providing these individuals with the hope that the medicines that they so desperately need will someday be available to them. 

Happy 4th of July!

Happy belated birthday America!   I can imagine the smell of charcoal with sausages and burgers over the grill.  I finally tried a burger here in Manila, but sadly, it just isn’t the same.  It definitely makes me miss home. 

As I celebrate this American holiday in a country thousands of miles away, it reminds me of the values and words written in the Declaration of Independence and the Constitution…the foundation on which America is based.  Similarly, I’m reminded of the words of another Constitution that are written on the wall outside of my school: 

“The enjoyment of the highest attainable standard of health

is one of the fundamental rights of every human being”

Written in many different languages on the wall, the most well-known line in the WHO Constitution highlights the fundamental necessity of equity in health…the foundation of my desire to work in healthcare.  These words reveal that the distribution of services is equally as important as its provision.  Based on my research, I’ve learned that too little attention that is paid to equity and often the most vulnerable groups are overlooked in priority-setting research, especially women.  Mental health problems, cancer, and obviously reproductive health conditions manifest so differently in women; however, too many organizations become too preoccupied with providing access without taking into account the mix of services being offered.  Forget about the biological aspect for a second – access to income and resources, status level, behavioral norms all affect women’s health, yet there is too little disaggregation of data by gender in health research.  And do you know what the scariest part is?  This type of research could ultimately wind up CONTRIBUTING to gender disparities.

To be honest, I don’t know how much I would have taken this dimension into account had it not been for the funding provided by the WAPPP.  But now, I have a chance to make my research matter more for groups that need the most help, and I’m really thankful for that perspective.  Looking back on the words of the WHO Constitution written on the wall of my school, it would usually be difficult to pinpoint any word or few words that are more important than the others.  Words like “enjoyment,” “highest attainable,” and “fundamental” could spark conversations that could go on for hours (and trust me…I’ve been in far too many of them in my classes).  But for this project…this summer, the important words are all too clear to me: “every human being.”