'Medicare portability' for Fil-Ams

Philippine Daily Inquirer/OPINION/by Ma. Ceres P. Doyo

It is supposed to be a win-win situation, with both the United States and the Philippine governments benefiting from it, but most of all, the Filipino-American Medicare beneficiaries who have contributed heard-earned money.

Many Fil-Am retirees, medical professionals and advocates in the US have joined the “US Medicare in the Philippines Campaign” to convince the US Congress and President Barack Obama to allow Medicare coverage in the Philippines. They are lobbying for the passage of the US Medicare Portability bill. Their campaign cry: “Bring Medicare Home! You earned it!”

If during your entire career you had contributed to a government health insurance fund and upon retirement you want to avail of medical care, wouldn’t you want to choose where to go? The land of their birth is the first choice of many Fil-Ams.

According to proponents of the Medicare Portability bill, Fil-Am immigrant professionals are retiring at the rate of 100 per day. They are part of the daily “tsunami” of 10,000 baby boomers who are reaching 65 years of age. Under US law, they can take their Social Security pensions anywhere in the world, but their Medicare coverage, unlike private medical insurance coverage, cannot be applied abroad, not even to their homeland where they are also citizens.

There is a tinge of hurt when they say, “Hundreds of thousands of Filipino doctors, nurses, medical professionals, teachers and workers immigrated in the ’60s, ’70s and ’80s upon the invitation of US medical and educational institutions and businesses to fulfill the needs of the American people. With decades of work they have paid into Medicare, they deserve portability of benefits at internationally accredited hospitals and care providers in the country of their birth.”

This will not be a drain on the US budget, they argue, but will in fact be a part of the solution to the worsening budget crisis. Here’s how: “The current annual cost per beneficiary is US$11,743. We estimate that taxpayers will save at least US$5,000 per year for each Filipino-American senior who chooses to return to his/her country of birth and avail of quality health care there.

“With this estimate of cost savings, if 200,000 retirees choose to reside in the Philippines, the Medicare savings would be US$1 billion per year. This dramatic savings could help meet our US government’s investments in job creation, education, infrastructure and small businesses, or reduce the budget deficit.” Health care in the Philippines is comparably cheaper.

The goal in 2010 is a change in the US law that would allow—for a start—for three demonstration hospitals in the Philippines that meet international standards to be reimbursed after Medicare beneficiaries are treated there.

This is far from saying that medical care in the US is inferior. Many wealthy Filipinos with health problems go to the US for treatment. What is clearly unsaid—and this makes me smile—is that many Fil-Am retirees feel and think they would live happier, healthier and longer lives in “Philippines, my Philippines.” The Department of Tourism’s “It’s more fun in the Philippines” campaign and its medical tourism program should get a boost from this.

Three days ago I spoke with Eric Lachica, a prominent Fil-Am registered lobbyist and organizer of US Medicare Philippines (www.USMedicarePH.org), a non-profit advocacy group based in Washington DC. Lachica spent years helping Fil-Ams get their due. A political science graduate of the University of Southern California and a son of a Fil-Am World War II veteran, Lachica worked 17 years for the passage of the Fil-Am Veterans Equity Bill that resulted in the 2010 release of $300 million for Fil-Am vets and their families.

The Medicare Portability bill lobbyist has been meeting with government officials in the US and the Philippines, President Aquino among them. Last November Lachica was invited to the Veterans Day Breakfast with President Obama at the White House.

According to Lachica the campaign has been making progress with P-Noy and Foreign Secretary Albert del Rosario. He said that last January the President announced that he will discuss the issue with President Obama in their June meeting.

Philippine hospitals that have signed up as partners are The Medical City, Cebu’s Chong Hua Hospital and Cebu Doctors Hopital. There are ongoing negotiations with Ayala Land, St. Luke’s Hospital, Makati Medical Center and Cardinal Santos Hospital.

Last week Lachica was in Guam to meet with Congresswoman Madeleine Bordallo who will be introducing a bill for Medicare coverage for in-patient hospital services in the Philippines.

On the Philippine side, we should be ready for this happy “tsunami” of retirees who are expected to experience first-class health care. Filipino caregiving is first-class and personal. Our tertiary hospitals have state-of-the-art facilities and medical experts galore. Unknown to many, foreigners are coming to seek treatment here and also enjoy the sights and sounds.

Hospices, retirement and nursing homes are still few on the Philippine landscape. But I’ve visited one that caters mainly to Japanese retirees and I liked what I saw. There should be more of this kind.

Not all of our nursing graduates can be absorbed abroad. Not all of them are raring to toil on foreign soil if they can help it. I believe that the Philippines has a lot to offer to fellow Filipinos who have left family, friends and village to seek greener pastures. And who now want to come home to the bosom of the land they love, to bask in its golden sun, to gaze at its blue seas and skies and the verdant hills beyond.

Welcome home.

Breaking the culture of silence, deafness

Philippine Daily Inquirer/OPINION/by Ma. Ceres P. Doyo

Speaking at a Vatican gathering, newly installed Manila Archbishop Luis Antonio “Chito” Tagle delivered his opening salvo thus: “The so-called crisis of the clergy unfolding these past years is immense in scope. It includes allegations of sexual misconduct, suspicions about the clergy’s handling of money, accusations of misuse of authority, inappropriate lifestyle and a host of other things. The faithful are appalled at the rudeness of their pastors. Priests who do not preach well or do not preside at sacraments religiously cause scandal as well. So when we refer to the crisis in the Church related to the clergy, we are dealing with a multi-faceted reality.”

There was reason to rejoice when the charismatic and hugely popular Tagle was called to Rome to speak at last week’s conference that tackled sexual abuse committed by priests against women and children.

Tagle delivered his talk, “Clergy Sexual Misconduct: Some Reflections from Asia,” before priests and bishops from 110 dioceses and religious from all over the world. They were expected to make guidelines on how to investigate allegations of abuses, help the victims and keep abusers out of the priesthood. A May 2012 deadline was set. This was a response to the scandals and exposés worldwide that rocked the Catholic Church.

Tagle gave an Asian perspective. He described how abuses committed by the clergy have been kept in the dark in a culture that regards sexual abuse victims as a cause for shame even while the abusers remain protected and continue their practices with impunity.

Tagle pointed to several aspects of the crisis generated by the clergy’s sexual misconduct: the personal/relational, cultural, ecclesiastical, legal, pastoral/spiritual and the media.

He explained that in Philippine culture, priests are usually regarded as family members and as more than ordinary humans. Filipinos are an affectionate lot, he added. “Because the culture clouds over the clergy’s humanity, some of them hide their true selves and lead double lives. Duplicity can breed abusive tendencies… What boundaries should we set to prevent expressions of affections from becoming tools of abuse?”

Tagle explained the ecclesiastical aspect thus: “When a cleric transgresses, even if the action is not criminal in the civil forum, ecclesiastical vows or promises are violated… A case in point is celibacy. A fuller and more just understanding should situate it within the Church’s rich spiritual, pastoral and canonical tradition. The crisis has impelled us to understand again the promise to remain celibate and lead a chaste life…

“Many people think that celibacy is simply a rule that the conservative Church has to observe for the sake of tradition. Some make it the culprit for all types of sexual misconduct. Others defend it but in a narrowly legalistic way that proves ineffectual.”

Tagle presented the Philippine Church’s pastoral responses to allegations of sexual misconduct, among them, pastoral care and even restitution for the victims and their families.

Asked Tagle, “How do we handle communities whose trust in their priests have been violated? Changing pastors is not enough. We should find an effective way of allowing people to voice hurts, to grieve, to understand, to forgive and to move on in hope. The Asian propensity to quickly restore ‘harmony’ often makes us believe that healing has already occurred when it really has not.”

And the offender? “The offender is usually lost, confused and shamed. He needs help, especially from experts, to understand and evaluate his situation. The priest can discover whether he has the capacity for celibate living. Some decisions have to be made.”

The archbishop happily noted that many priests, religious women and men and laypersons in Asia have been preparing themselves professionally to be of help to clergy with special needs. The Catholic Bishops’ Conference of the Philippines now operates the St. John Marie Vianney-Galilee Center for Priestly Renewal to offer various programs, among them, pastoral care of priests with problems.

The non-offending clergy who feel lost, shamed and confused also need care. Just as important is the pastoral care of superiors and bishops who have to act as both carers and judge. Many have been accused of covering up or playing deaf. “Experience has taught us that inaction, mere geographic transfer of priests and insensitivity to the victims compromise the integrity of the religious superior or bishop.” Tagle commended the Federation of Asian Bishops Conferences’ Office of the Clergy for the programs that equip bishops of Asia to handle sensitive cases.

And lastly, seminary formation and ongoing formation for priests must examine the roots of the crisis in the context of Asian realities. “Because of the specific crisis we are facing,” Tagle stressed, “we need to revitalize the community life of priests, common prayer, sharing of resources, spiritual direction, simplicity of lifestyle, and academic renewal among other things.”

I have reviewed the book “That She May Dance Again: Rising from pain of violence against women in the Philippine Catholic Church” (2011) authored by Sr. Nila Bermisa, a Maryknoll Sister, and published by the Women and Gender Commission of the Association of Major Religious Superiors in the Philippines.

The book should be read by those who serve in the Church so that they may see the painful realities and understand the root, history and dynamics of the experiences that many women have suffered in secret.

The book’s opening lines: “To become an interruption, perhaps a prophet to the Church hierarchy that for so long has denied women of equal dignity and full humanity.”

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OFWs stricken ill

Philippine Daily Inquirer/OPINION/by Ma. Ceres P. Doyo

Nanay Flor Tejada, for years an overseas Filipino worker in Hong Kong, lost her daughter Armyn, also a Hong Kong OFW, to breast cancer in 2008. The following year, her other daughter, Nene, also a Hong Kong OFW, followed suit because of colon cancer. Both Armyn and Nene died in Hong Kong. After Nene’s passing, Nanay Flor went home to the Philippines to care for a son who was diagnosed to have liver cancer and eventually died. Not long after, Nanay Flor herself found out that she had lung cancer. She is now struggling to live and get healed.

Nanay Flor’s story is among the many stories in “running priest” Fr. Robert Reyes’ book “Buhay Ka: Struggles in Mortality, Glimpses of Eternity” that documents Hong Kong OFWs’ battle against cancer. The book was launched on Feb. 4, World Cancer Awareness Day and will soon be available at Popular Bookstore. Philippine Medical Association president Dr. Oscar Tinio wrote the foreword.

The stories in the book are not just about OFWs who were stricken ill and waged a battle against a dreaded disease in a place so far from home and loved ones. It is also about Filipinos caring for fellow Filipinos in difficult and extraordinary circumstances. And while work and disease are the common denominators for these OFWs, many of whom are domestic helpers, their cases and the nature of their battles are as varied as the lives they left behind in their home country.

Reyes who was assigned in Hong Kong for several years and who considered himself an OFW began his “street ministry” in Hong Kong by organizing a band of OFWs who called their group Lakbay Lingap. Writes Reyes, “Every Sunday, sometimes Saturday, we would meet and walk to the various meeting places of the thousands of OFWs… Every other OFW we met seemed enclosed and even imprisoned by their story of loss.” Thoughts of an unfaithful husband, children in trouble and debts at home plagued them. “And then there were those whose health have suffered a serious downturn, those who have been diagnosed to have cancer.

“After the streets, members of Lakbay Lingap began visiting hospitals. It was there that we met Lydia Bartolome who allowed us to journey with her and led us to others like her. I was not familiar with the hospitals of Hong Kong. Soon we were visiting Queen Mary Hospital, Prince of Wales Hospital, Pamela Eudes Hospital and so many other hospitals that hid so many of those who were hailed at home as heroes. What kind of heroes were they now that they were sick?

“Thank God, their employment in Hong Kong included medical insurance, but only while they were employed. As soon as a worker is terminated, and unless she finds another employer, in two weeks she has to leave Hong Kong lest she be penalized for overstaying.”

It was during his meetings with the ailing OFWs that the priest often heard the lamentation, “Mamamatay ako.” (I am going to die.) And so he would often hear himself counter with, “Pero buhay ka pa ngayon. Sabihin mo nga, buhay na buhay ako.” (But you are still alive. Say, I am very much alive.” And so the name “Buhay Ka” was adopted for the group of OFWs who were battling cancer and other ailments.

Included in Reyes’ book are the reflections of Melina Lagarbe, Buhay Ka coordinator. She says, “Today, Buhay Ka-Hong Kong is one of the richest Filipino communities (here), not because of money but mainly because we are blessed with all the beautiful, special, wonderful, triumphant and defining moments… Despite our busy schedules as domestic helpers, we still manage to do something for others.” But she says she also must deal with the patients’ doubts and fear of the unknown.

“Buhay Ka” the book is like a scrapbook, a compilation of reflections in both English and Filipino, first-person accounts, letters, interviews and photographs. Sure, it needs some good editing, but the individual stories, complete with names and faces, are so real one will just have to ignore the lapses and the book format.

Some of the first-person accounts were written when the OFWs were undergoing treatment. Having lost their hair to chemotherapy, many are shown wearing bandanas in photographs, but smiling broadly with their fellow OFWs who had cared for them. Not a few lost the battle but not before realizing their worth and experiencing the love and care of their compatriots and even strangers in a place that was not their home. Compassionate employers who went the extra mile deserve special mention.

There were those who survived cancer despite all the odds. For many, it all started with a “bukol sa dibdib” (a lump in the breast). One OFW went back to Hong Kong despite the adverse diagnosis and hid her condition from her employer. She needed to earn and see her daughter graduate. She worked for a while but when her employer decided not to renew her contract, she sought refuge in Buhay Ka which took care of her before and after her operation and until she was well again.

Caregivers blessed with good health and hearts have their stories, too. Who said OFWs are only concerned about their families back home, that all they do is slave away to earn? Many able-bodied OFWs have time and energy to spare to care for OFWs who are stricken ill.

Some of them have experienced kindness and are paying forward, so to speak. Others are driven by their religious faith and patriotic fervor. But there is no doubt that they have a deep well to draw from—because they are Filipinos. Father Reyes, a Hong Kong priest-OFW himself for several years, became one of them—a spiritual caregiver, accompanying many ailing OFWs in their healing journey and to the threshold of eternity.

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Cancer and medical tourism

Philippine Daily Inquirer/OPINION/by Ma. Ceres P. Doyo

While health and tourism officials as well as health institutions are doing their best to promote medical tourism in the Philippines by way of drawing foreign patients to avail of Filipino medical expertise, Chinese hospitals are beating them through aggressive advertising right in our own home ground. This is especially so in the cancer department. But this is getting ahead of the story.

The third week of January being national Cancer Consciousness Week and Feb. 4 being World Cancer Day, the Philippine Society of Medical Oncology (PSMO) recently held a press conference to brief the media on the national cancer situation and other related issues. PSMO’s campaign theme is “Fighting Cancer: Education, Prevention, Treatment.”

Founded in 1969, PSMO is a scientific, professional organization of medical oncologists (now numbering 146) committed to the advancement of the science and the ethical and holistic practice of medical oncology. This means active participation in national programs and campaigns to promote cancer awareness and safe practices in the field of medical oncology for optimal patient results.

The national picture is not pretty. Studies from 2008 to 2010 have shown a steady increase in cancer incidence. PSMO cited Globocan research estimates that in 2012, new cancer cases (in men and women) will be roughly 82,460. The top cancer sites in women include breast, cervix, uterus and lungs, while in men they are lungs, liver, colon/rectum and prostate.

The good news is that more advocacy groups are spreading cancer awareness. Said PSMO president Dr. Felycette Gay Lapus, “Every day is cancer consciousness day for us. We seek to arm the public with as much information as possible. Prevention is the ultimate goal, but if that can’t be achieved, it is important to get proper and safe treatment as early as possible.”

PSMO vice president Dr. Ellie May Villegas said that earlier detection and better treatment have resulted in decreased cancer deaths (18 percent) in the United States since the 1990s, reversing decades of increases. “Hopefully, the Philippines will follow suit,” she added.

Dr. Dennis Tudtud shared the latest research findings in occupation-related cancer. Unknown to many, there are carcinogenic chemicals in the work place that increase the risk of cancer.

An issue that came up in the press conference was the aggressive advertising of Chinese hospitals to entice Filipinos to be “medical tourists” in China. In the past months major dailies carried ads that boasted of new technologies and innovative treatment procedures for cancer patients in China. These ads even carried stories of individual patients (non-Filipinos) who purportedly benefited from the treatments.

Representatives of a Chinese hospital even go to schools with Chinese-Filipino population to do their promotion. Their target audiences are not the students but the Chinese-Filipino parents. This is according to a doctor (with Chinese ancestry) from a well-known Metro Manila hospital. Her daughter is a student in one of the schools visited by promoters.

This doctor happens to have experienced first-hand what going to one of these China hospitals was like. Her own brother who had lung cancer died within seven months despite assurances from the Chinese doctors that he was “95 percent cured.”

This doctor’s brother had undergone procedures here and in Singapore, chemotherapy among them, but these were not completed because, before she knew it, her brother and his family had decided that he should go to China for treatment. Despite doubts, the doctor did not get in the way of her brother’s desires. She had no clear idea what he was going through. All she was told was that her brother was getting better.

On the patient’s last trip to China things went awry. “I got a call. I spoke to a doctor who spoke broken English but we could hardly understand each other. I decided fast, got a visa and flew to China.” She was upset by what she saw.

“People at the airport were not familiar with the hospital even though its name rang a bell in the Philippines. Well, it was a building on what looked like Avenida Rizal, right close to the street. You should be able to imagine that. My brother was on the seventh floor where the well-off were supposed to be. While he was dying there was nothing attached to him, not even oxygen. He died 15 minutes after I arrived. The hospital had no morgue. He had to be brought to some place.”

And then there’s the issue of so-called radioactive seed implantation. Oncologists shared horror stories about patients coming home from China with the still radioactive seeds inside them. “Pity the airplane passenger sitting beside a radioactive patient,” said an oncologist who knew of such cases.

So why aren’t the Filipino oncologists, among the best in the world, and the state-of-the-art procedures in our five-star hospitals, not being aggressively promoted? They are medical tourism’s best kept secret. “We don’t have the funds,” Lapus lamented.

Book launch: On Feb. 4, “running priest” Fr. Robert Reyes will launch his book, “Buhay Ka: Struggles in Mortality, Glimpses of Eternity” that documents Hong Kong’s overseas Filipino workers’ (OFWs) battle against cancer. The venue is the St. Dominic Medical Center in Bacoor, Cavite where visiting Canadian doctors will present a new program and equipment for early cancer detection. Reyes’ book will be available at Popular Bookstore on T. Morato, Quezon City.

Reyes had accompanied many women OFWs on their journey towards healing and to the threshold of eternity.

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