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.”