Mar 162013



by Professor Roland G. Simbulan



Vice Chancellor for Planning and Development, University of the Philippines, Manila;

Co-Convenor, Gathering for Peace




Address before the National Conference of the Philippine Rural Reconstruction Movement, PRRM Auditorium, Quezon City, January 10, 2003.



I deeply appreciate this opportunity to address the Philippine Rural Reconstruction Movement (PRRM) which has, since the 1950s, been serving our farmers and rural poor. I am greatly honored by the fact that your Board of Trustees and officials here at PRRM are made up of eminent Filipinos widely known for their dedication to the largest sector in Philippine society, the poor peasantry in the rural areas.


As we convene today, the war drums of the United States are again preparing for an attack against a sovereign nation in the Middle East, Iraq. According to a study released last Nov. 12, 2002, titled, “Collateral Damage: The Health and Environmental Costs of War on Iraq,” by the International Physicians for the Prevention of Nuclear War (IPPNW), an association of medical and public health experts that was the recipient of the 1985 Nobel Peace Prize, “a US-led attack on Iraq would result in between 48,000 and 260,000 deaths during the first three months of combat.” According to the IPPNW, “Neither Iraq’s suspected weapons programs nor Saddam Hussein’s tyranny provide moral or military justification for risking the lives of massive numbers of innocent civilians.” IPPNW thus made the appeal: “We urge all nations to spare the innocent in favor of full and effective inspections.”


This recent study by that international association of medical and public health practitioners and researchers, the IPPNW, based its projections on the 1990-1991 Gulf War, which caused nearly 200,000 casualties in Iraq, mostly civilians. It analyzed current US combat scenarios and concluded that a new conflict would be much more intense and destructive than the first Gulf War.


Dr. Amy Sisley, a professor of surgery at the University of Maryland Medical System, explained in the IPPNW study, “ In an era where images of combat are beamed from aircraft, it is too easy to forget about the direct, physical consequences of war. Bombs deafen, blind and blow apart people, riddling them with shrapnel, glass and debris. They collapse buildings on victims, including hospitals and clinics vital to treating the wounded. Unexploded ordinance left behind kills and maims, and battlefield toxins can contaminate the environment for decades. “


Dr. Robert K. Musil, executive director of the American Physicians for Social Responsibility, summarized the public health impacts in the report:


“Even so-called high-tech war wrecks a society’s human service systems and physical infrastructure by disrupting delivery of food, water, medicine and energy supplies. The loss of these necessities of life leads to infection, disease, malnutrition and starvation on a massive scale. “


As emphasized by Dr. Victor W. Sidel of the Albert Einstein College of Medicine and past president of the American Public Health Association, “a pre-emptive attack would exacerbate the disastrous levels of health, disease, disability and despair already present in Iraq.” Furthermore, according to the IPPNW study, the aftermath of a US-led attack could include civil war, famine, epidemics, millions of refugees and economic collapse. It would be a “human catastrophe.”


If this would be the scenario, why is the administration of President Gloria Macapagal-Arroyo supporting US President George W. Bush’s aggressive drive to plunge the world into a horrible war that will heighten the cycle of violence ignited by Sept. 11? Why is our government supporting a war that no less than Pope John Paul II, in his Dec. 25, 2002, Christmas message has condemned when he said that, Bush’s call for a “preventative war is an act of aggression”?


Furthermore, it is a US-provoked and initiated war that we are being asked to support against a sovereign country which has full diplomatic and consular ties with the Philippines! And no less than former US President Jimmy Carter, also a Nobel Peace Prize winner, has criticized his own government for its double standards against Iraq and North Korea when it “(failed) to cooperate with international efforts targeted to prohibit the arsenals of biological weapons that we ourselves have and to enforce the agreement to eliminate chemical weapons, and the same way with nuclear weapons.”


We must be remember that the United States has the largest arsenal of nuclear, chemical and biological weapons in the world today. What moral right then does this superpower — well-armed with all the weapons of mass destruction that it asks others to disarm — have in calling for a “regime change” against another sovereign country that is a member of the United Nations AND WHICH HAS FULL DIPLOMATIC RELATIONS WITH THE PHILIPPINES? Is the US telling us that might makes right?


The lives, health and safety of an estimated 1.4 million Filipino overseas workers in the Middle East may be imperiled as they will be caught in the crossfire of a full-scale attack by the United States against Iraq. Philippine Foreign Affairs Secretary Blas Ople must either be joking or hallucinating when he said that if war breaks out, “things will be okay simply because we are ready to evacuate 147 Filipinos in Iraq.”


A US-led war of aggression against Iraq will fan the flames of violence and counter-violence already evident in the region. As such, casualties may not be limited to those in Iraq. Any attack on Iraq will most likely affect and put to risk neighboring countries like Saudi Arabia, Kuwait and the United Arab Emirates where the bulk of Filipino overseas workers are located since the United States has military facilities or forces there. There are 400,000 Filipino workers in Saudi Arabia alone.


Here at home, where the Arroyo administration has committed to fully support the US’ so-called war against terror, not only will the Philippines have to absorb and expose itself and its people to retaliatory attacks by enemies of the United States. Paranoia has spread like wildfire and is now an epidemic among our national security and defense officials who are pushing for the fast-track approval of the Anti-Terrorism Bill, the local version of the US Patriot Act and Homeland Security Act. Those two measures have virtually transformed the United States today into a police state that legalizes warrantless arrests, illegal detention and interrogation, racial profiling and indefinite detention. Wiretapping or eavesdropping into private communication is now standard operational procedure not only among US law enforcement agencies but also state and federal agencies.


What then is the best antidote against terrorism?


As a result of these international and local developments, the urgent and pressing basic needs of the Filipino people are being further neglected. There is a saying among development planners that, “The real policy is where the money is.” Now, in our national budget, where is our money going? Does it give priority to our people’s basic needs like health care, education and housing? Does it give the highest importance to the poor and needy, especially the farmers and workers who make up the largest sectors of Philippine society?



I now realize the low priority that the government is giving to health and education, as well as other basic services to the poor, while giving the higher priority to the military and police budgets. For the coming year, for instance, UP’s health sciences colleges will experience a slash of 14.75% while the PGH budget will be cut by 5%.


In the context of the anti-terrorism bill being discussed in Congress, this low priority given to basic services such as health and education will all the more make our country a haven for so-called terrorists who are disillusioned and angry at the government. This explains why there is the absence of health and medical people to care for the overall health and sanitation needs of the people especially the rural poor. For the most important legislation against terrorism is an increase in the budget of the basic social services, namely health, education, and housing, rather than relying on the military and police solutions. If government were really serious in snuffing out terrorism and insurgency as well as reducing criminality, then it should give greater priority to basic social services. In effect, a pro-poor national budget would be the best anti-terrorism legislation.


Hopefully, this low budgetary priority will not aggravate the continuing “brain drain” or bleeding of our health and medical practitioners to other countries due to horrific work conditions and low salaries here. In fact, it may be said that many of our health professionals are overworked, our hospitals and clinics are dilapidated, and our equipment are obsolete precisely because of the low budget allocated for health.


Yet, these budgetary woes do not affect the military and police who, in lieu of the people, are apparently the real foundation of President Macapagal-Arroyo’s avowed “strong republic.” The budget next year of all the Armed Forces of the Philippines military units—General Headquarters, Army, Air Force, Navy and Presidential Security Group—increases by P4.23 billion for a total of P37.8 billion. This includes the additional P2.95 billion for AFP salary increases and an additional P800 million for 7,000 new soldiers. Meanwhile, budget items of P1.43 billion for paramilitary CAFGUs and P96.3 million for the so-called Balikatan exercises remain.


The Philippine National Police (PNP) is likewise unaffected by budget difficulties. The administration is aiming for an additional P2.31 billion for the PNP which brings its total budget to P35.3 billion. This includes the additional P2.1 billion for PNP salary increases and additional P300 million for 4,000 new police. The Dept. of Budget and Management has also said that there is, on top of these, an additional P855 million for 5,000 new policemen, jailguards and firemen.


The huge increases in the military and police budgets are in stark contrast to the huge cuts, or otherwise grossly insufficient spending, for social services for the general public. These cutbacks continue a trend that has been worsening since the mid-1990s.


Cutbacks in basic social services


Health sector spending falls by P502.2 million to just P14 billion. Taking into account inflation and population growth, real health spending per person falls from P170 in 2002 to P152 in 2003 (in 2001 pesos). Yet even in health spending the military bias is clear. The Department of Health (DOH) budget is cut by P488 million and the combined budgets of the Lung Center, Kidney Institute, Heart Center, Children’s Medical Center and Alternative Health Care Center are cut by P16 million. However, the budgets of the two military hospitals—the AFP Medical Center and Veterans Medical Memorial Hospital—is increased by P26 million. These two military hospitals alone take up 9.6% of the total health sector spending.


The story is the same for social security, welfare and employment spending which are slashed by P184.7 million to P33.8 billion. The Department of Social Welfare and Development (P99.9 million cut), the Philippine Overseas Employment Administration (P11.7 million) and the Presidential Anti-Poverty Agencies (P9.6 million) bear all these cuts to enable the increase in the AFP pension fund which, at P22.6 billion, takes up a massive 66.8% of the social service sector’s total spending.


Meanwhile, the housing budget is going to be cut by P307.5 million to just P1.7 billion, which is less than a sixth of its level in 2000 and the second lowest housing spending ever. Real housing spending per person then falls from P26 per person in 2002 to just P18 per person in 2003.


The education budget nominally increases by P982.8 million to P129.9 billion. But this is still insufficient to make up for inflation and student population growth and real education cost per person still falls from P1,516 per person in 2002 to P1,413 per person in 2002. And again, the military bias is present. The budget for state universities and colleges is cut by P143.9 million and for the Philippine Science High School/Science Education Institute by P28.3 million yet the budget of the Philippine Military Academy is still increased by P30.2 million.


The National Budget cannot but reflect the government’s political priorities. In the case of the proposed 2003 General Appropriations Act, President Macapagal-Arroyo’s priorities clearly are similar to the US’ defense budget hikes amid the anti-terrorism war. The government may have somehow found reason to increase spending on the military and police despite very real budget difficulties. For the social services that the people so badly need, however, it seems no reason is ever good enough.


The Paradox of Philippine Medicine


It is often said that medicine in the Philipines is a paradox. This is so because while we are the largest exporter of nurses and the second largest exporter of doctors in the world, especially to North America, many of our own people at home die without any type of health care, living their lives without having a single medical checkup. Our own health statistics further bolster this strange paradox: the majority of our rural population, who make up the majority of our people, never enjoy the services of doctors.


It also comes as no surprise that our infant mortality rate is still very high ; many of our children are malnourished and many of the rural poor still have no access to safe drinking water. Even the figure of the average number of Filipinos who die of violence every year would pale in comparison with the annual average of those who die of illness or disease.


The above paradox makes us ask the following questions: Is this proof of the unresponsiveness and irrelevance of present medical education to the needs of Philippine society? Is the effectiveness of medical education lessened by diseases that stem from and thrive on economic, social and political maladies?

Is social commitment wanting among Filipino medical practitioners today?


To answer these questions, we have to painfully dissect the anatomy of our sick society. Doctors, nurses, interns and other medical practitioners have long been agitated by the continued deterioration of government hospitals and clinics, deterioration caused by government neglect and indifference to the needs of basic health services. The measly budgets of government hospitals expose the distorted sense of priority of our society. Military expenditures and debt servicing have risen while expenditures for health and education are always pegged at a very low level.


If government neglect of our health care system is tolerated and “income generation” instead of social commitment is nurtured in the minds of our medical practitioners and medical students, then it is no wonder why our medical graduates disdain medical practice in the Philippines. They remain unprepared to work in an environment of poverty where the problems are malnutrition, infection, public health, mental health and sanitation. Current statistics show that about 15,000 nurses from our 45 nursing schools leave the country annually for employment in foreign hospitals. At our premier state university, the University of the Philippines, 90% of the alumni of the College of Nursing are working abroad while the figure is at least 65% for our College of Medicine.


The Plight and Flight of Health Practitioners


The education of the health practitioner has, as a whole, become commercialized and dominated by private, profit-seeking schools. If a medical student becomes a government doctor, his daily pay is less than what a janitor in the United States (or in Canada) would earn in less than two hours!


Profit orientation makes the health practitioner aspire for the bigger hospitals serving the rich few or the highly advanced countries which offer sophisticated, expensive, technologically complex, curative and hospital-oriented medicine. From his expensive, imported medical textbooks, the doctor may learn about rare cases of medical disorders but would not know how to diagnose, treat or manage an outbreak of measles in a remote barrio because he could heal solely with the use of drugs with scientific-sounding names accompanied by complex laboratory examinations and huge, fully equipped medical centers. And since his training conditions him to prescribe the new but very expensive medicines and gadgets of the foreign-dominated drug and hospital industry, often times, the government physician or health practitioner has to even shell out his or her own money to try to save the dying patient.


The doctor is made to realize early that, should he want to be a “successful” physician, he should associate well with the local drug industry which is controlled by foreign vested interests. For he needs the drug industry to sponsor him for a generous scholarship in foreign specialization, donations of books and medical equipment, and sponsorship of physicians’ scientific meetings in five-star hotels.


Thus, it is not surprising anymore to learn that despite the state subsidy given to medical and health education, almost 65% of our alumni at the UP College of Medicine are in North America, and that we are training health practitioners in the fields of nursing, physical therapy, etc. basically for foreign practice. This situation obviously can only be at the expense of the more fundamental medical and health needs of the Filipino people. This is the reason why I am convinced that to the popular slogan at the state university, ISKOLAR NG BAYAN, we must add the phrase MAGSILBI SA BAYAN!


Our nurses, on the other hand, which comprise the biggest number in hospital and clinical staffs, are beset not only by low wages but also by poor working and living conditions. Their workloads are usually heavy while wages are sometimes delayed or are below the statutory minimum wage. The Philippine Nurses Association (PNA) estimates that on the average, a nurse attends to 40-60 patients per shift, giving medication, charting records and performing special procedures for critically ill patients. For this work output, they receive a wage hardly enough to meet personal and professional needs.


Even medical and health workers now accept that economic and political realities account for the health of a community, if not an entire nation. The World Health Organization (WHO) defined health in its founding Constitution (1947) as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” Since disease and ill health are realities of institutionalized hunger, poverty and the despair of the exploited and oppressed, health solutions are inseparable from the larger solutions to society’s ills. Since ill health and disease are largely a product of the social and economic organization of society, the question of health and illness is really a political question and the fight for better health is a political struggle. For poverty and ill health are situations brought about by economic factors, such as foreign domination and a market-oriented economy, and political factors, such as lopsided priorities and decisions that benefit only a few in society.


National policies like privatization, deregulation and market liberalization, which are supposedly “efficient” from the management point of view, are in fact anti-poor and work against increased subsidy to the basic social services. Militarization, on the other hand, is a machinery of death that has contributed to the ill health of the people. Ultimately, these maladies can be cured not by the scalpel alone but by a more equitable distribution of economic wealth, more economic opportunities, and more resources for public health.


Clearly, all health care is now seen as a multi-product of society and a good thermometer of society’s health in its national situation. But I am happy to note that growing numbers of medical practitioners,health workers and researchers are trying to pursue a more active role in people’s service by responding to the needs of the times and developing social consciousness as well as firmer social commitment to the Filipino people. Groups like the Health Alliance for Democracy (HEAD), Alliance of Health Workers (AHW), Medical Action Group (MAG), Council for Health Development (CHD), and others are relating the nation’s health problems to the larger spectrum of socio-economic conditions. Nurses, doctors, health professionals and even medical students are joining community-based health programs knowing fully well that an effective health program must be based on strong mass support. Continuing education on socio-economic, political, economic and cultural issues should be tackled side by side with the teaching of basic health care.


One of our units at UP Manila that is based in Palo, Leyte, the School of Health Sciences (SHS) with its community-based approach to health care, emphasizes the use of traditional , indigenous and other alternative approaches that are effective but least expensive. It is a fine example in reorienting a profit-oriented, foreign-dominated health industry, especially in the pharmaceutical sector. Along with the fledgling organizations of the people in the barrios , community-based health programs like the SHS’ should encourage people to collectively analyze the roots of their ill health and poverty. This is necessary to enable them to do away with long-held myths on health and medication, learn the more scientific explanations for their basic health predicaments and come up with practical solutions to their concrete conditions and needs.


Conditions in most of our government hospitals and facilities today reflect an aspect of our country’s overall social cancer and can, in fact , become the concrete rallying point for the participation of our medical and health practitioners in the broader struggle of our people against disease and poverty.


Our rural people’s organizations and NGOs like the Philippine Rural Reconstruction Movement (PRRM ) should recognize the important role of medical practitioners in the overall struggle of the Filipino people for a better life. Health workers and practitioners are closest to the people in the most desperate, crucial times of their lives. They are with the people as the latter try to surmount crises in health, in suffering and in dying. Having committed themselves to the alleviation of pain and the healing of disease, they have openly proclaimed their partisanship in behalf of man’s struggle against suffering.


On the other hand, our medical practitioners should not take a limited outlook on the obligations of their professions. Their horizons should not be circumscribed by the four white walls of the hospital. The cycle of human pain and suffering extends far beyond physical disease and goes into the heart of exploitation of man by man.


The same spirit that infuses medical practice also infuses political activism—the struggle against political, economic and cultural oppression. Partisanship against physical disease is also partisanship against the perpetuation of poverty, ignorance , hunger and filth, as there is that dictum that, “to heal is already to choose”.


For, to physically heal one’s patients in the hospital and then send them back to that degraded social condition where diseases thrive, is to sorely fail in one’s medical and social obligations.


Because of the medical and health profession’s high level of respect, community exposure and dedication to combating disease, his/her profession is an ideal vehicle for educating the public and creating an awareness so that the conditions that are at the root of the disease and suffering can be minimized , if not eliminated. As the American Physicians for Social Responsibility so aptly put it, “When medicine cannot handle a disease, there is only one way to deal with it—prevent it.”


A scientific analysis of the reasons and means by which the masses are maintained in degradation is indispensable to anyone who wishes to act on the social cancer that afflicts our people. Identification of the social problems that cause the malady is a prerequisite to correct diagnosis and consequent measures.


If the Arroyo administration were really serious about renewing itself, then it should integrate into its national agenda the pro-poor and pro-sovereignty programs and implement these with priority budgets to assure their realization. People’s movements as well as revolutionary movements are not struggling and sacrificing just so that certain leaders will get positions of power without altering priorities or reforming the system.


That is why, the highly publicized suggestion (of Speaker Jose de Venecia) to “form a government of national unity” that would invite leaders of rebel groups like Jose Ma. Sison and Hashim Salamat into the cabinet is a laughable suggestion, at least for genuine leaders of the people. It is a measure to coopt or even bribe with positions of power and privilege the leaders of people’s movements—a tactic utilized since the Spanish, American and Japanese colonization of the Philippines. In those days, our colonizers bribed weakling resistance leaders with local positions of political power so they could be used against their own people who were resisting colonization.


A good start instead would be for the Philippine government to implement the pro-peace provisions of the Philippine Constitution by, for example, not supporting Bush’s war preparations against Iraq and instead working for peaceful negotiations towards disarmament. Arroyo can also begin a true renewal by asking her supporters in Congress to give budgetary priorities to vital basic services like health, education and housing for the poor, instead of the military, police and intelligence budgets. As I said earlier, this is the best antidote to the “terrorism threat”. This is just to remind us that so long as the root causes of grave social inequalities are unresolved, rebellion and uprising will remain an attractive option to the unfree and the poor.


I would like to end with a positive note since it is the beginning of the year: I am glad that there are still people , ordinary people in our country who are rising way above the low standards of leadership set by our government leaders. During my visits to the provinces, I have always been inspired by our barriofolk in the rural areas with their virtues, honesty and goodness—despite adversity and poverty. One cannot fail to notice their firm bond of fellowship and community spirit. But more than ever, despite all adversity and pessimism and against all seemingly overwhelming odds in our quest for justice, freedom and national sovereignty, let us not forget what Robert Michels wrote in his book on political parties:


“Organization is the weapon of the weak in their struggle with the strong.”




The date posted here is due to our website rebuild, it does not reflect the original date this article was posted. This article was originally posted in Yonip in 2003




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