10. DISASTER MANAGEMENT
No doubt, the devastation that four typhoons (Ondoy, Pepeng, Ramil and Santi) brought in the entire Luzon in September and October was the biggest story of the country in 2009. However, the relief and recovery operations of government agencies, including that of the DOH, were sidetracked as mere politicking in the eyes of the media. No matter how hard it tried, the DOH’s HERO (Health Emergency Relief Operations) found no match with Sagip Kapamilya or Kapuso Foundation efforts. The power of media prevailed.
Somehow, and without much fanfare, the DOH continued its operations by fielding medical teams and distributing medicines and safe water to evacuation centers and communities in devastated areas.
9. SEX VIDEOS & MEDICAL PRACTICE
Hogging the media coverage on Influenza A (H1N1) in the middle of the year was the leaked sex videos of cosmetic surgeon Dr. Hayden Kho, Jr. with a number of female partners, notably actress Katrina Halili. The DOH was briefly dragged into the controversy in May when Halili asked the revocation of the license to operate of Vicki Belo’s beauty clinics for “recklessly” allowing Kho to perform liposuction on her despite the fact that he lacked qualification, training and specialization as cosmetic surgeon. Halili said Kho passed the medical board exam only in February 2007 and the liposuction surgery was done in August 2007. According to her legal counsel, this violated the DOH’s Rules and Regulations Governing the Licensure and Regulation of Ambulatory Surgical Clinics, which states that surgeons should at least have a four-year medical residency before practice.
In September, the Philippine Medical Association (PMA) suspended Dr. Hayden Kho for two years for “conduct offensive to the profession. However, on November 20, the Professional Regulations Commission (PRC) found Kho guilty of “immorality and dishonorable and/or unethical conduct offensive to the profession” and ordered his medical license revoked. According to news reports, Kho would appeal this decision.
Veteran actor Johnny Delgado passed away on November 19 at the age of 61. Former President Cory Aquino died on August 1 at age 76. Master rapper and TV host Francis Magalona died on March 6 at age 44. Delgado had lymphoma or cancer of the immune system; Aquino had colon cancer; and Magalona had leukaemia or cancer of the blood. Cancer is the third leading cause of illness and death in the Philippines, and in 2009, well-known personalities succumbed to the disease.
This year, the DOH started providing free opioid analgesics for indigent patients suffering from severe pain due to cancer, HIV/AIDS and other chronic diseases. They can avail of these drugs from DOH hospitals and participating hospices nationwide. Moreover, the DOH has boosted its “HL (Healthy Lifestyle) to the Max” advocacy to prevent and control the four major chronic diseases – cancer, cardiovascular diseases, chronic obstructive pulmonary diseases and diabetes.
7. POLITICAL ADS?
The Senate and the judiciary seemingly undermined DOH health promotion efforts by relegating its “infomercials” (paid public service advertisements) as purely political in nature. In August, then Health Secretary Francisco T. Duque III and other cabinet members with infomercials were summoned to a Senate hearing. In another development, the Manila Regional Trial Court released a temporary restraining order to stop advertisements bearing the faces and campaign slogans of “political wannabes.”
For decades, the DOH has been using mass media as part of its health promotion strategies to disseminate important messages for disease prevention and control. The traditional means of community-organized lectures, classes and meetings could only do so much. With the country’s growing population, the DOH needs to expand its reach through mass media. It is not only effective, it is also cost-effective if it is compared to the expenses that may possibly incur when thousands of the public get sick.
It turned out, on December 1, the last day of filing the Certificate of Candidacy in Comelec, Duque did file for any elected positions.
In January 2009, the US Centers for Disease Control and the US Food and Drug Administration reported a Salmonella Typhimurium outbreak and the sources were peanut butter and peanut paste produced by the Peanut Corporation of America in Blakely, Georgia processing plant. Salmonella bacteria are responsible for causing typhoid fever, diarrhea and gastrointestinal diseases.
This prompted the Bureau of Food and Drugs (BFAD, now known as the Food and Drug Administration) here to issue advisories to the consuming public against certain US brands of peanut butter and other peanut-containing products. BFAD also conducted its own tests on products currently sold in the market.
In March, the BFAD confirmed that some local brands of peanut butter also tested positive for salmonella. The involved food manufacturing company was subjected to further inspection and BFAD found that it continuously failed in its Current Good Manufacturing Practice. As a result, its license to operate was suspended. In April, upon the orders of the DOH, the salmonella-positive products were destroyed through proper incineration by a qualified disposal facility in Taguig City and following the strict mandate of the Clean Air Act.
5. EBOLA RESTON
As early as 2007, an increase in pig mortality in swine farms in the provinces of Nueva Ecija and Bulacan occured. This prompted the government to initiate laboratory investigations on sick pigs and samples were sent to international reference laboratories. In October 2008, results confirmed that the pigs were infected wth a highly virulent strain of Porcine Reproductive and Respiratory Syndrome as well as the Ebola Reston virus (ERV).
In January 2009, a Joint Mission composed of animal and human experts from the Food and Agriculture Organization, the World Organization for Animal Health, the World Health Organization and the Departments of Agriculture and Health carried out a full risk assessment of the ERV situation in quarantined farms in Bulacan and Pangasinan. In February, upon the recommendation of the experts, the depopulation of pigs was done in affected farms to prevent the further spread of the virus.
The DOH enjoined the local governments, the hog industry and the public in the four lines of defense – 1) report unusual occurrences of sick or dying pigs to local agriculture authorities; 2) adopt security measures to prevent and contain outbreaks in pig farms; 3) prevent the entry of double-dead meat into the market; and 4) thorough cooking of pork and pork products by the public.
4. DRUG TESTING OF STUDENTS
The “Alabang Boys” mess caused a stir in media and this prompted President Gloria Macapagal-Arroyo to proclaim herself as the “Drug Czar” and she ordered the immediate nationwide random drug testing of high school students to determine the current incidence of drug use, to provide a deterrent for those using drugs and to provide the necessary services they need to stop further use. Thus, starting in February 2009 and towards the end of the year, an estimated 85,000 students would be randomly selected and tested. The final results may take next year to be announced.
According to Section 36 of Republic Act 9165 (Comprehensive Dangerous Drugs Act of 2002), students of secondary and tertiary schools, shall, pursuant to related rules and regulations as contained in the school’s handbook, and with notice to parents, undergo drug testing, whether in public or private schools, and such cost will be borne by the government. Now, the DOH is proposing amendments to the law for drug testing to be made mandatory and the fees shall now be borne by the student. Also, in order for mandatory drug testing to be effective, the implementation scheme should provide mechanisms that would ensure that the students do not know the time when the drug testing will be conducted. This means that the students can be tested anytime during the school year (from enrolment to the closing of the school year). In this case, the problem of addiction can be nipped at the bud.
Dengue, the disease that usually end up in the Top 10 Health News, was ousted by another “rainy season disease,” leptospirosis. The great floods that crippled Luzon gave way to the surge of the flood disease. Leptospirosis is acquired not only from absorbing contaminated floodwaters through cuts in the skin but also by swallowing the bacteria directly from water or through food. Although the disease is commonly associated with rat urine, infection can also come from animals like cattle, pigs, horses, dogs, and wild animals. The disease causes a wide range of symptoms that begins with flu-like symptoms (fever, chills, muscle pain, intense headache) and may end up in meningitis, liver damage (causing jaundice), and renal failure. Death may also occur.
The DOH also saw a niche in the media coverage of disaster management with its efforts to employ and deploy health teams to help address the growing number of leptospirosis cases in typhoon-affected areas. On October 12, a few weeks after Ondoy devastated many parts of Metro Manila, CALABARZON and Central Luzon, the DOH had already recorded 383 cases of leptospirosis in nine Metro Manila hospitals. This is already half of last year’s annual figures. And as more typhoons came affecting Northern Luzon, more cases were being reported.
The DOH entered into a memorandum of agreement (MOA) with PhilHealth-accredited private medical facilities where the government can refer leptospirosis patients that state hospitals can no longer accommodate. The DOH subsidized the financial requirements of indigent patients that it referred to these hospitals. Moreover, the DOH invited a team of international experts to help the government respond to a large-scale outbreak of leptospirosis. The four-person team is made up of specialists from Australia, France, the Netherlands and Singapore.
As of November 13, there were 2,292 confirmed cases of leptospirosis with 178 casualties as reported by the DOH National Epidemiology Center. These cases were gathered from 15 government and private hospitals and medical centers in Metro Manila.
On the other hand, a total of 1,090 confirmed cases with 71 deaths have been recorded in Ilocos, Central Luzon, CALABARZON, and the Cordillera Administrative Region. The Ilocos Region had the most number of cases at 464.
2. MAXIMUM DRUG RETAIL PRICE
After long and tedious battles with multinationals for years, the Universally Accessible Cheaper and Quality Medicines Act of 2008 (Republic Act No. 9502) was signed into law in April 2008 and it meant an expected price reduction of medicines in the Philippines. One of its most salient provisions is giving the President the power to set price ceilings on various drugs, upon the recommendation of the Secretary of Health. And on August 15, 2009, it is time for the public to reap, as a 50% price reduction took effect in 38 drug molecules (72 drug preparations) or medicines against hypertension, diabetes, influenza, hypercholesterolemia, cancer, arthritis, goiter, allergies and infections. This has been termed as the Maximum Drug Retail Price or MDRP.
Of course, the MDRP implementation was confronted with hesitations and objections. Small and medium-sized drug outlets with manual systems, except those in front or near hospitals, were given until September 15 to comply. Pharmaceutical companies cautioned the government against imposing price ceiling on some medicines, saying it might lead to the easing out of the Philippines on the list of priority countries that will get the newly released medicines. The Pharmaceutical and Healthcare Association of the Philippines threatened to hold “hospital holidays” and increase other hospital fees to cope with loss of income because of the cut in drug prices.
But then, Mother Nature intervened. The devastating typhoons came and the bickering stopped (momentarily?!?).
1. INFLUENZA A(H1N1) PANDEMIC
The novel disease that scared the globe is the No. 1 Health News for 2009.
At 10:30 pm of May 21, the DOH officially announced the first confirmed case of Influenza A(H1N1) in the Philippines, a 10-year-old girl who just in from a trip to the US and Canada. Since then, the health workers in the field and in hospitals worked diligently to stall the increase in the number of cases by testing each person who manifested flu-like symptoms and contact tracing as well as treating accordingly those who were affected. As this happened, several schools and workplaces with confirmed cases shut down for days to prevent further spread of the disease.
Influenza A(H1N1) is a highly infectious disease caused by a virus which mutated out of four different strains of the influenza A virus found in pigs, human and birds. The outbreak began in Mexico in April 2009, spreading across the Americas and Asia in a matter of months.
On June 11, the World Health Organization (WHO) declared that the world was facing the highest Pandemic Alert level (Level 6) on A(H1N1). The WHO described the virus as ‘‘contagious and highly transmissible from person to person.’’ At this point, the DOH informed the public that it was shifting its A(H1N1) measures from containment to mitigation should community-level transmission happen in the country. A community-level transmission is present when the source of the virus can no longer be traced clearly and was already widespread. On June 22, the first locally reported H1N1-related fatality was a 49-year-old woman who also suffered heart problems. She was also the first fatality in Asia and among the 180 fatalities reported worldwide.
On June 30, the DOH issued revised guidelines on the response levels for schools and on clinical care management of H1N1 cases as well as new guidance on major policy changes from containment to mitigation response. The shift would mean that A(H1N1) would be treated as the common flu, some patients can be treated at home while those with underlying conditions would still require hospitalization, i.e. if a person has progressive symptoms and preexisting conditions like asthma, heart disease, diabetes, pregnant, malnourished, and has HIV or TB.
On July 9, the WHO commended the DOH for its “leadership and tireless efforts in responding to this emerging threat.”
At of the last count, more than 99 percent of A(H1N1) cases in the Philippines had recovered, with the 30 who died having suffered from other diseases like heart and liver disease.
On August 5, the WHO reported that 1,154 cases worldwide have died since the virus emerged in April.