Log in

25 April 2014 @ 11:20 am

So much time has elapsed and I no longer feel the need to blog.  I am in a happy place right now.  After much struggle, I have completed my MD degree in the Philippines.  I am still healthy and alive.  I have an amazing wife, the kind of relationship I never dreamed were possible.  I am in a new chapter in my life, where I am struggling to enter a US residency training program...

My blog was written in good faith, but it is so naive.  My perspective on the Philippines was that of an outsider, whereas now, as a Tagalog and Cebuano speaker, I view it from the inside.  Its no longer a foreign country to me, but a second home.  There are only two ways to study in a foreign country - complete isolation from it, and social networking with other foreigners in order to avoid the frustration of dealing with an unfamiliar culture - or complete immersion.  I did the latter, and the result is that I, myself, have become partly Filipino.  This is why, from my new perspective, many of my past thoughts and observations now appear quite silly.

But the most naive of all, was my perspective on the education here. I thought the basic sciences matter.  They do - they are the basis of all medical knowledge, but how they are TAUGHT is irrelevant.  Pick up a damn book, learn it yourself - no problems there.  But the clinical sciences aren't necessarily found in one book.  Supervision, instruction, training - they aren't optional for the clinical component.  And having had US rotations as well as Filipino rotations in multiple hospitals, I can say with confidence that clinical training in the Philippines lacks severely in supervision, discussion, and patient centered approach.  While we become experts at certain procedures, there is a great deal more leeway for being wrong - far more than is acceptable for US standard of care or standardized examinations. And preparing for the clinical board components after having clerkship in the Philippines makes you feel like you are learning something new - not reviewing.

Im not bitter, I survived.  I survived the brutal 36 hour shifts, I survived the power trips of my superiors (such as making me come in to work while having profuse amoebic diarrhea - under the threat of repeating a rotation; or giving me a 240 hour duty extension on a single day for the "crime" of being 5 minutes late to the OR due to a meeting with the Dean), I survived the relentless proselytizing of religion and the threats of expulsion for respectful non-participation in public prayer, I survived!  But not without help... from friends, from classmates, from kind hearted residents (especially one in particular who stopped me from quitting when I felt like its all too much for me), from my family that gave me emotional and financial support when I needed it most, and my beloved former girlfriend now wife... who stood by me even when I ignored her....   They will all have my undying gratitude....

So revisiting my past topics... Is a Filipino education superior to the Caribbean?  In my view, no.  Unfortunately, most of the skills expected of US medical students at the clinical level, are taught in the Philippines during residency training.  For medical students, clinical training consists of lots of discipline, lots of pressure, lots of exposure - but little knowledge, little independent thought, little ability to plan, manage, order, assess - KEY skills in US clerkship.  Medical students in the Philippines are trained to do unfocused and complete physical examinations, often following a memorized script of normal PE findings....  There is no focus at all on developing a clinical eye, or determining the appropriate exam and treatment.  Also, there is very little supervision as to whether maneuvers are being done correctly or not (except for surgical/OB settings where it could be life threatening).  Caribbean opportunity to learn these skills in the US is a HUGE advantage which i underestimated.  Even with the whole "green book" mess that potentially limits the number of states that one can be licensed in, after attending an unscrupulous Carribbean school with multiple "blue book" US rotations - its still a better education.

However, other things I thought remain true.  The Philippines is a LOT less corrupt than the Caribbean, from everything Ive seen.  The cultural experience of studying here is a HUGE personal asset, even if it is not that important professionally.  I have no regrets as to my education.  And even with a sub par clinical experience, I still am perfectly capable of passing the US board exam.  And I still owe a factor of 8-10 less money because I studied here rather than the Caribbean.  And above all, I met the love of my life here:)  It matters....

So I will end this by saying that you have to want to be a doctor REALLY REALLY REALLY bad to do some crazy shit like go abroad.  Its worse than you imagine, its so hard you wont even believe it.  Your body, your mind, your very essence will be at a breaking point at multiple times..  DONT DO IT, unless you cant live without it.  And if you cant live without it - then it ultimately doesnt matter where you do it.  You will persevere.  You will survive.  What isnt taught to you - you will learn.  Nothing will stop you if you are willing to stop at nothing....

This is my last entry to this blog.  I made it.  Time for the next chapter...

01 November 2009 @ 05:48 pm
I recommend to everyone to get sick in their lifetime.  Seriously sick.  Hopefully without long term consequences, and definitely surviving in the end - but try at least once to get a diagnosis that evokes more fear in others than you feel within yourself.

The personal reflection and the subsequent "new outlook" on life that is brought on by a serious diagnosis had been described ad nauseam.  What is less commonly known is the social rearrangement that occurs when you go "public" with a disease.  Initial sympathies give way to two basic, equally surprising reactions:  Half the people you thought were completely on your side just back away, in best cases afraid of being hurt by your pain or the possibility of losing you - a natural reaction for someone with strong geniune feelings towards you, and at worst, to protect themselves from being in a position to be asked for help.  On the flip side, half the people you barely knew, people who were in the "just regular friends" category suddenly become your best friends.  They actively seek out communication with you, and give help at every corner.  Again, in the best case scenario, these people are taking the opportunity to become a closer friend, something they've wanted to do, and now they see a real possibility of not getting that chance any more.  In the worst scenario, they are scoring points with their personal god, or simply following a moral teaching about helping the sick and go home patting themselves on the back about it. 

All this reshuffling completely changed my life.  I've discovered close friends I've never known I had.  I flushed a few friends i thought were close to me down the toilet.  And for the less clearcut cases, Im still the same - trying not to judge until I know for sure - not only the reaction of the person, but what motivated that person towards that particular reaction to the news of my illness.

And then there is a third category of people that I just don't understand.  These people pop into my life and infrequent, irregular intervals and collect information.  During those appearances they share very little about themselves.  But they do ask a lot of questions.  After their curiousity has been satisfied they disappear into the oblivion until their next reappearance, lest they be the last to know of a new development.  I'm really not sure what to make of these people.  Is it their way of showing concern?  Am I a fool to honestly reveal to them all the answers they seek, knowing that having fed upon the information they'll once again  become invisible in my life?  I dont know what it is that causes them to be this way.  But I know what its not.  Its not genuine attachment.  Its not genuine care.  Even if they root for me, I'm like a TV show to be tuned to once in a while.  And this one-way information exchange is fooling nobody.  And if you think that for one second I don't notice your closed heart in response to my open one, think again.  Yes, you, chipmunkface.  I know you're reading this.
01 October 2009 @ 02:23 am
I've never thought this possible.  Having cancer is barely on my mind these days.  What is on my mind every day, throbbing painfully and growing like a tumor is the same thought over and over - HOW CAN I GET BACK TO MEDICAL SCHOOL.  I've played it back and forth.  If I stay in the US, I can't possibly enroll before fall, 2011.  And then I have to repeat first year medicine again.  But going back to the Philippines is a risk for my health.

Which do I choose?  Physical health or Sanity?

I'm thinking about going back this May, against medical advice.  I'll be a 2nd year medical student again.  I can graduate 2013.  I can be in residency by 2014.  If I stay here and go the US route, there is no way in hell I'll graduate before 2015.  

One route cant be used as a backup plan for another.  If I go the US route, I have to repeat my MCATs which expired this year.  I have to retake Physics II.  I have to boost my application with graduate classes.  But if I go back to Cebu, I should use the time now to study for the USMLE, to preview 2nd year subject material.  What to do?  I need to make decisions now.... and these are Life or Death decisions.  Literally.

17 August 2009 @ 12:34 am
He lived a strong and relentless life.... ok ok ok not that kind of obituary.  But I do feel somewhat sentimental towards the pathology report.  After all, this is the last time anyone will write anything about him.  So, what does it say, and what do I think of it?

Tumor size:  greatest diameter is 1cm (good news)
Tumor type:  mixed germ cell tumor containing:
seminoma (classic type)
embryonal carcinoma (bad news)
yolk sac tumor (good news)
immature teratoma (bad news)
the dominant tumor is embryonal carcinoma (90%) - (shitty news)

Intratubular Germ Cell Neoplasia identified (duhhhh)

Vascular Invasion not identified (great news)

Tunica albuginea not involved (great news)

Rete testis involved

epididymis not involved

spermatic cord and surgical margins not involved (good news)

non-neoplastic testis
unremarkable (WHAT??? it was my pride, my joy, the passionate moment's slap on some lucky girl's butt..... HOW DARE THEY CALL IT UNREMARKABLE!!!)

rest in peace my overworked friend.  You'll be missed by all!!
02 August 2009 @ 09:19 am
July 20 - primed by Neoplasia discussion in Gen Path, and a recent breast exam discussion in Physical Diagnosis, I perform a testicular self-exam, and find a small, hard nodule on the superomedial side of my right testicle.
July 21 - I skip PCM to see a urologist who is surprised that I even noticed something so small.  He orders AFP and bHCG bloodwork and a testicular ultrasound.
July 22 - too many exams to worry about my health
July 23 - After acing my morning quiz in PD, I go over to Chong Hua for the ordered tests.  In my mind, Im trying to reconstruct who I might have slept with last year, thinking that the nodule is perhaps a result of some untreated STD.  My fantasies of an easy (although embarrassing) resolution shattered during my ultrasound.  I saw what was clearly a solid mass in my testes.  When the radiologist turned on the doppler effect, I saw intense vascularity around the mass, unlike anything else within the remaining testicular tissue.  After the ultrasound, I picked up my blood work and saw a normal AFP and an HCG of 6 (normal 2 or less).  Not caring any more as to what class Im skipping, I rushed back to the doctor whose response was simply, "you are a medical student you know what all this means." Duh.
July 24 - After a lightening-speed review of related literature, I concluded that the the first and only step in treatment would be a right radical orchidectomy.  I contemplated doing this in the Philippines, but two factors just didn't fit with the plan: 1) Pathology results would have been less reliable, and 2) there is no non-latex protocol in any hospital in Cebu.  When I asked my doctor how he would perform the operation given my latex allergy, his response was quite simple: "without gloves".  That was enough for me to beg my friend for a favor - and she came through and got me a next day airplane ticket.  The rest of the day was spent at the Cebu Bureau of Immigration where I was milked out of 9580 pesos just to get my exit papers.  I wonder if bribing the official at the airport would have been cheaper, but whatever.
July 25 - packed my most important things, leaving just about everything behind.  Said goodbye to friends.  Got on the airplane.  Goodbye Cebu.
July 26 - Spent the day walking around Seoul, waiting for my connecting flight to New York.  Got screwed new-york style when I ended up paying about 5 US dollars for some spicy chicken feet at the local market.  Sen-chon is a place I could definitely hang out for a few days.
July 27 - early morning applied for medicaid, made an appointment at Sloan Kettering hospital (one of the best cancer hospitals in the world) in 4 days, called my long time physician and told his secretary what happened.
July 28 - my physician saw me between surgeries and looked at my test results.  Referred me to a prominent Oncological Urologist at Columbia Presbyterian.  The latter physician floated the possibility of a wedge resection of the tumor as an alternative to a radical orchidectomy.
July 29 - CAT scan and ultrasound showed no visible retroperitoneal lymph node enlargements and only mild tumor growth, respectively.
July 30 - One of the leading testicular cancer experts at Sloan Kettering tells me that a radical orchidectomy has a better prognosis than a wedge resection.  Based on this information, I schedule the surgery for the following day.  Almost blocked from scheduling the operation by the hospital's financial department.  Apparently Sloan Kettering policy is not to accept any payment from Medicaid applicants.  Instead they file a financial assistance application that can take a week or more to approve.  Since all procedures are refundable once Medicaid is approved, paying out of pocket for the initial tumor removal will expedite the procedure (no waiting for financial assistance approval) without any monetary loss.  However, once you show the hospital your pending letter for Medicaid they will not accept that prepayment. Since the chance of metastasis is increased with each day of waiting, it may constitute an increased risk to the health and survival to show that letter to Sloan Kettering.  Therefore, if you have the ability to borrow money to prepay the initial procedure, do not show Sloan Kettering your pending Medicaid letter but register as a self-pay.  Once the procedure completes, show the pending letter and go through the financial assistance approval while you wait for tumor pathology to come back.  Once financial assistance goes through, you will no longer need to pay for Sloan Kettering services, and once Medicaid goes through you will be refunded for the initial procedure that was paid for out of pocket.
Unlucky for me, I didn't know this, but lucky for me, the financial officer took pity on me and broke with the rules as an exception (and got yelled at by his supervisor for it).
July 31 - Right radical orchidectomy performed at Sloan Kettering.  A nurse anesthesist student present in the OR first notices signs of allergic reaction at the last phase of the surgery, and sounds the alarm.  Still under anesthesia, I enter full-blown anaphylactic shock due to the presence of a single latex-containing instrument during the surgery (a rose pen drainage device).  With BP 70/30 and significant laryngospasm, I am treated with benadryl and albuterol.   However, laryngospasm may have had nothing to do with the allergic reaction (skeletal muscle), and the albuterol while acting as a bronchodialator may not have done much to improve the spasm in my larynx.  Bottom line is I came out of this ok.
August 1- After being kept overnight for observation I am released to go home.
August 2 - updated my blog.  Planned out my new life.  As long as my survival odds are 90% or better getting back into medical school will remain my number one priority.  Steps to achieving this priority might include: 
1) Using my diagnosis as a foot-in-the-door for doing cancer research at Sloan.
2) Retaking Orgo 2 lab end lecture since I never passed this premed prerequisite.  I better get an A or else I suck.
3) Possibly retaking my 2006 MCATs.  I scored a 32 last time, so I should aim for a 36 this time.
4)  Getting appointments with deans of various medical schools in order to get a realistic assessment of my med school application as well as the possibility of transferring my filipino credits.
All this will go into effect immediately unless i am assigned to chemotherapy.  In the latter scenario, I should wait till I finish chemo before embarking on this new journey.

02 August 2009 @ 09:11 am
This has been one hell of a ride.  From the NMAT testing room in the Philippine embassy in LA, to the PBL classrooms of CIM, to the lecture halls of MHAM, my medical education experience was a little more colorful than most.  And now, having been diagnosed with testicular cancer, Im back in the USA, following yet a different path towards my goal.  This blog will continue to track my path towards an MD degree, this time as I struggle to apply to medical schools in the US.  Also, I will be frank about various developments in my cancer treatment, so that everyone else can also benefit from my unique educational experience as a patient.  Finally, as always, Ill continue to vent my mind as things bother me:).  

So here is my new old blog.  It starts now.
08 July 2009 @ 08:28 am

My idea was simple.  As 2nd year medical students, we are expected to examine patients in hospitals, and 2/3 of us will be doing our duty in government hospitals.  We will be touching, examining, talking to some of the least affluent folks of Cebu city and province.  And gloves won't be provided, as a routine, to save on government funds.


We all know the risks.  We've all taken parasitology, and are currently taking microbiology.  As future doctors we assume the risk of being the first line of defense against any plague or epidemic that might roll into town.  Somehow, we can only hope, but can't guarantee that our increased exposure to pathogens will not make us sick individuals.

So when I finally got a correct diagnosis for my itch, I thought it would be interesting to make it public.  It was a contagious parasitic infection called scabies (which I probably picked up from a hotel bedsheet while on vacation with my parents in Bohol).  It is inexpensive to treat, and by the time I was making it known to my classmates, I was already well into my treatment which probably made me noncontagious at that point.  Nonetheless, I was curious as to how my medical classmates would handle the news.  The results were astounding!  Based on class behaviour, i'd say it took about 2 weeks for the rumor to fully circulate (the information was originally seeded by a status post in facebook, and verbal mention of my affliction to a few classmates). 

Of the future doctors, the following groups could be observed:

Daredevils, 10% - these were individuals who for shock value or perhaps in support of my situation (both my affliction and the whispers behind my back that some may have thought i was unaware of) increased their physical contact with me compared to the usual, by patting me on the back or initiating handshakes. 
Don't cares - 30% - these were folks whose behavior did not change, and perhaps this group is confounded by those who didnt know - but its unlikely since in the Philippines no rumor goes unheard.
Confronters - 10% - these were classmates who actually asked me questions about my condition, or let me know that they are aware.  They were upfront about their fears of being infected, and we had a dialogue over how it can be avoided.
Avoiders - 20% - these were classmates who significantly reduced their physical contact with me due to the rumors.  These range in intensity from avoidance of handshakes to "this seat is taken" type of behavior.  To avoid bias, some alleged avoiders were tested by lightly touching on the shoulder from behind in order to initiate conversation.  A strongly negative or a startled reaction was interpreted as a confirmatory sign of avoider status.
Panickers - 10% - these were classmates whose reactions were simply off the wall.  I am talking entering an elevator crowded with classmates on the way to class, and finding myself in an empty half while 10 people huddle together in the full half.  Some panickers significantly increased their standing distance from me during conversation, although scabies is clearly not transmissible through air.

So my percentages don't add up and I don't care.  Just view them as proportions.  The bottom line is that I had no idea id encounter such diverse reactions from a group that studies the same knowledge of disease, infection and epidemiology, and is taking the same risks in terms of disease exposure in career.  Which group do I like best?  Probably the confronters.  These guys clearly have a fear of being infected, but still persist in getting to the truth and are willing to base their interactions with me on evidence rather than rumor. As for panickers and avoiders?  I dont mind, else i wouldn't have made this little experiment.  It was definitely not personal.  I do feel tho that these categories really need to examine their motivations for becoming physicians.  Starting this week, you'll be touching patients some of whom carry multiple parasites and infections, some who havent seen a doctor in years, some who live alongside sewage rivers, kids who swim in sewage canals by the road during rain, and older, immunocompromised patients who are host to multiple contagious diseases.  Are you up for the risk? 

Oh and in case anyone wonders, im ok already:)

30 June 2009 @ 12:32 am
I woke up at 7:30PM...  a quick nap after school recharged my batteries.  I walked back to the University to meet my frat bros there.  It's about 20 minutes, as I traverse the market area, then walk past the barbeque stalls behind the city hospital, steaming with charcoal grilled intestines and chicken heads.  I cross the highway, and enter the narrow alleyways of Sambag 1, where after multiple left right left right turns I smartly exit the labyrinth right next to the back gate to the school.  After meeting my two friends, we took a taxi into Guadalupe, an upper middle class residential neighborhood where in the back yard of an inconspicuous residential house, a Basque immigrant to the Philippines cooks and serves authentic spanish food at a minimal cost.

After dinner, my friends dropped off in their dorm, and I headed to the study center.  Outside the convenience store, people were drinking Red Horse beer, and up the stairs through the back of that store is the study area where I do most of my productive reading.  Quiet, air conditioned, with clean study stalls and medical books available for use it's a great place for those late night crams.  

For some reason, studying didn't go well for me tonight.  At 15 minutes to midnight, i gave up, and went walking back towards the University.  Although it was already midnight, I was sure the laundry shop was still open, and i was right.  The owner quickly loaded my clean clothes onto his minivan, and drove me home to drop me along with my clothes. 

After changing at home, I went out again, to come to this internet cafe.  Market area never sleeps, and some of my neighbors were still outside - some drinking, others just talking.  I walked over the short bridge over the "stinky river".  This is where a lot of people without a place to stay hang out at night, this is also where tricicad (manual bicycle with a carriage attached next to it) drivers hang out during those hours where they are unlikely to find passengers.  There was a small television outside one of the 24 hour snack shops, and about 30 people gathered around to watch a Michael Jackson video (for the Philippines, which are culturally stuck in the 80s, it was an even bigger shock that he died.. since his songs are still quite current here, and often played in public venues and clubs).  i made my way down the dark street, towards the internet cafe.  Some young people in front told me, "Hey joe, where you going joe".  Annoyed, I answered, "Kinsa si Joe, uy!  Ambot niya..." and left them scratching their heads, trying to figure out if I am a fil-am or if I am a white-looking offspring of a foreign tourist from 30 years ago...

and now im sleepy and will go home again.  I am sure whoever is reading this is sleepy too.  This is the most senseless, noncontroversial, and boring post I'd ever made.  And im posting it anyway.

24 June 2009 @ 06:40 am
.... and now it's hot like lava on my mind.  If this was just an incident or two, I would dismiss it as an exception, limited to a particular individual.  Instead, I am constantly reminded that doctors in the 21st century continue to work within the constraints (and often do their part in supporting) the barbaric practices of the dark ages.  Im talking about misinformation and at times negligence that occurs between doctor and patient, or self-imposed by the patient himself - all in the name of pleasing a God.  This has furthermore, leaked its way even to institutions of medical learning, to poison future doctors' objectivity while it's still budding.  

Where does this ignorance come from?  From some of the brightest minds, no less!  The concepts I'm discussing here have originated from docs who were and still are my favorite educators.  The ones who are some of the most accomplished not only in school, but of great respect and status in the community.  Frankly, they are some of my favorite professors.  That's why it hurts double, to realize that the pre-scientific fear of the elements of nature, and their iron-age explanations will affect the way even these amazing doctors talk to, and treat their patients.  Some examples, spoken in class:

1)  Masturbation causes impotence, and promiscuity will severely damage your health even if you use protection.
2)  WHO's drive to promote condom use in third world countries is not a desperate effort to thwart the spread of AIDS, or to put food on the table of indigent families who already have too many mouths to feed!  Oh no, it's a first world conspiracy to limit the number of "inferior" peoples being born!

This is not to say that there needs to be much teaching in regards of placing mythology over public health.  The soil is fertile for medical concusions which may serve big daddy in the sky, rather than the patient.  After a discussion of pharmacognosy (the sources of pharmaceuticals that we use), we were given a chance to talk about why studying it is important.  One of my classmates who happens to be very bright, and also happens to be muslim, had this to say:
"It is important to study pharmacology because it teaches us about where our drugs come from.  For example, today I learned that insulin may come from swine, and it is something I now must consider."

Consider??  Even if we imagine the best, that she will go beyond religious superstition (it's not even the actual religion, since the Qur'an probably discussed eating pig, not injecting it parenterally), and decides to prescribe it as treatment to her diabetic patients.  What of her guilty conscience?  Can you imagine doing what's right (saving a life) and all the time thinking that your true creator, your purpose of living HATES you for it?

This is not a Filipino problem, but a worldwide epidemic of faith-based ignorance.  Consider the US, and it's protection of religious rights.  A child whose parents are Jehova's witnesses may be denied an emergency blood transfusion on the basis of his parents' beliefs. In other words, if God tells me to sacrifice a child in his honor, I go to jail for murder.  But if it's written in a book, then the parents may FORCE me, the physician, to sacrifice a child, or ELSE I go to jail!

There are some values that are so basic and universal, even animals understand them.  Life over death.  Comfort over suffering.  And when it comes to issues of what we eat, and who we fuck all western religions have waged (and so far, won) a battle to increase death over life, to promote suffering over comfort.  Sex is not a safe activity.  As physicians, we need to ensure our patients understand the risks of promiscuity.  But to ENSURE that understanding by INCREASING that risk (by discouraging condom use as a Western conspiracy, and making abortions illegal and forcing women into getting their abortifactants in online chatrooms and bulletin boards - which i visited, and found with horror that they are often given partial medication and instruction on phamaceutical abortion) - that is the height of unethical.  Surely, if we found out that the government is lacing illegal drugs with pesticide, we would not defend it by saying that people shouldn't do drugs in the first place.  And yet when it comes to increasing the risks of Sex, our society defends it using religious moral-babble. 

And for the record, there SHOULD be freedom of belief.  If someone wants to believe that their house cat is the incarnation of Mohatma Ghandi, it's ok.  But if they bring that cat to a human hospital, a physician should refer that person to a veterinarian.  And, thankfully, we can still inject Jewish and Muslim children with insulin if they need it.  Although I wonder if there are some fanatics out there who would deny a child that lifesaving medicine on the grounds of  21st century BC and 8th century AD science, respectively.  I postulate that the REASON why the insulin thing has not been a subject of hot legal debate (as opposed to blood transfusions and contraceptive family planning) is that Judaism and Islam are still looked down upon in Christian societies.  If swinophobia was in the New Testament, it would have the same legal backing as the other issues 

I hope I can survive the pressure to conform.  As a physician, I will no doubt be subjected to all kinds of political and legal pressures.  But once I take that hippocratic oath I will not break it! I will be true to scientific truth, and the results of free scientific inquiry.  And the things I do and say will be for the benefit of my patients only.  No harm will come from me.  I promise.
09 June 2009 @ 06:21 am
I don't think I could ever be a surgeon.  No, I just can't be.  I was truly fortunate to have been invited to come along on the medical mission organized by a local rotary club.  The 6 hour boat ride landed us on the beautiful Camotes islands..  Breathtaking views!  The local government, apparently unable to furnish enough vans or jeepneys to transport 60+ people, kindly provided us two garbage trucks, which hauled us to the local hospital where we slept a few hours on the hospital beds in the ward before the morning onslaught of patients.

And what a stampede it was!  150+ circumcisions, almost 60 surgeries (including 2 thyroidectomies), dozens of internist consultations, and a live birth, all completed before 5PM that day.  Understaffed and overwhelmed, the organizers put everyone to work, even us - first year medical school graduates - myself, and 2 of my frat bros.  We performed several circumcisions (we, i mean mostly my bros as this was my first mission, and they've done this before).  I assisted, I sutured, I cut a few times, but I think my hands are just too awkward for this kind of work.  I mean, I did what had to be done.  But I lacked the grace, the precision, and I would describe my work as barely adequate.

Afternoon we were placed to assist surgical residents in performing operations.  My job was retracting tissue, wiping the surgical site in order to keep the view free from blood, and passing instruments.  There were two especially interesting cases I've got to assist in.  One was a neoplasm of unknown origin on the hand of a teenage boy.  The tough palmar fascia, the involvement of tendons in the tumor, and the proximity of arteries made this operation somewhat challenging for a field setting.  About 90% of the tumor was extracted; the remainder could not be touched without injuring the tendon.  The sad part was, we had no biopsy capability.  The tissue was thrown out.

The second procedure was something that cannot be witnessed in the first world.  It was the last surgery of the day, and an older man came in with a 12 year aged cyst on his upper posterior thigh.  I understand the surgeon's desire to operate - if he hadn't the man would wait another 12 years to seek medical assistance again.  However, we were all out of surgical blades.  So, the operation was performed without a scalpel.  A sterile needle was used to cut superficial tissue, while scissors were used to cut deeper.  To make matters worse, the sebaceous cyst turned out to be larger internally than visible on the surface.  It was fluid filled.  What was supposed to be a 10 min procedure under lidocaine local anesthesia became a 1 hour ordeal for the patient.  After a second shot of lidocaine, the doctor did not want to risk overdosing with the third.  The last 15 minutes the operation was done on the sensitive patient. 

There is no doubt that this procedure needed to be done.  The fluid filled cyst could have burst internally.  It could turn malignant.  And the man clearly had no resources to go to a big city to have this surgery.  But I don't think I could handle this situation, as a surgeon.  My stomach still twists in knots.  Maybe some day ill put the good of my patients above my personal stress levels.  But if I go on this mission again, i think i'll stick to IM clinics, at least the next time.
13 May 2009 @ 05:18 am
It's official now.  It's been two years since I've embarked on my filipino journey towards a medical degree.  Although I've clocked a bit less time than that due to my 2-month visit in the US in 2008, I can feel undeniably the impact of these two years on my mind and my psyche. Two years.  In Asia.  In Philippines.  A country which I would have previously been unable to find on a map without labels.  A country whose culture and people were a total mystery to me just two short years ago.  I remember after I took my NMAT in LA, I had lunch with the first SELF-ADMITTED filipinos i'd ever met (turns out much of my former classmates and colleagues were pinoy, I simply had no idea that they were).  I remember asking, "is filipino culture more like Mexican or like Chinese?"  Perhaps asking if eggplant tastes more like chocolate cake or like baked chicken would have been a more intelligent question...  

I read over my first post here, and I have to say that nothing I've stated regarding Carribean vs. Philippine education has significantly changed as I gained more experience attending medical school in Cebu.  To anyone who doesn't qualify for acceptance in the US, I still say that the Philippines offers a much better value for offshore education than the Carribean.  And having seen many of my upper classmen go abroad to do some of their 4th year rotations leaves me with no doubt that attending a Carribean money factory for "US rotations" alone is a poor justification for the exorbitant cost.

At the same time, I became a bit wiser in that I know that a single prescription cannot fit every patient.  There are certain students for whom the extravagant cost of a carribean education would not be a hinderance especially if:
1) A student doesn't care about a California license.  There are a few reasonably priced, and adequately run Carribean schools (i.e. Windsor) which are not accepted by all 50 US states.
2) A student cannot and will not give up Western excesses and all aspects of Western-style living, and/or does not wish to integrate into another culture.  In that case, the Carribean campuses, isolated from their island society, are perfect "incubators" for such medical students.  They can effectively limit their interactions to fellow students all of whom are from the US - and avoid the pitfalls and challenges of an intercultural education.  
3) A student with family attachments requiring them to come home on a moment's notice.  Fact of the matter is, flying from the Carribean might take at most 9 hours, or as little as 4 hours depending on location.  In an emergency, a student can fly home after friday's class, spend saturday at home, and fly back in time for Monday's quiz.  A 16 hour direct Manila - New York or a 12 hour direct Manila - Los Angeles flight makes that option impossible.  And at a much higher ticket price.

However, for a student with my set of preferences and goals, the Philippines is the best offshore option.  And so far, I feel Cebu is the best option within Philippines. Also, after toying with the possibility of transfers to other schools within the Philippines for second year, I've come to realize that my choice of MHAM - Southwestern University was the best one for my needs and goals, and remaining there is the best move for me.

So, I am here.  Two years.  And Im happy.  And Im moving forward.  And Im looking forward to my return to the US as an MD.  Three years to go!
18 April 2009 @ 11:01 pm

So, filipinos know how to party after all.  I never expected the party to happen during Catholic holy week, and especially not in the provincial area like the Bantayan island (provincial cebuanos are a very conservative religious lot) - but it was actually a pretty good party.  Lots of makeshift stages set up along the sandy shores, alcohol sold everywhere, and the rebellious new generation of filipinas daringly displayed themselves in "gasp" two piece bikinis.  In fact this was the first time I saw filipinas wearing anything other than a t-shirt and shorts to go swimming, with no foreign influence of any kind behind it (normally, only foreigner girlfriends/partners are seen in such skimpy attire).

Why am I so excited about it?  I guess we Americans no longer appreciate the value of personal expression, because its no longer forbidden.  If skin is no longer shocking, the only way to shock the American party crowd would be to take off pieces of skin, a square inch at a time.   But here, where abortion is still considered murder (but infanticide committed by the mother or her parents during first three days after birth is punishable by a slap on the wrist, if it is done to, "preserve family honor"), where contraception is a sin, where catholic prayer is regularly broadcast in malls, hospitals, and other public areas - a piece of skin is really more political than titillating.  In liberated American society, it seems that the only way to, "stick it to the man" would be to commit an act of violence.  So perhaps its a good thing that Filipinos are subjected to scrutiny when it comes to personal expression.  This gives the rebels a socially unacceptable way of acting out without actually hurting anyone.  And I was glad to be a witness to it all.

PS:  One thing that sets the filipino religious conservatives apart from their "born again" counterparts in the US is their primary focus on socially visible behavior, rather than the "internal" salvation and acts done in private.  So far the newspapers have been talking a lot about the bikinis during the party (example: http://globalnation.inquirer.net/cebudailynews/news/view/20090405-198012/Ban--bikini-parties), but one thing that was completely left out is that there were private tents available for rent for a very reasonable price right there in the dancing area.  So a couple who wished to engage in what the American conservatives would characterize as sinful behavior, would need to do nothing more than take a few drunken steps from the dance floor, and $6 later would find themselves in a private setting!    I have a strong feeling a similar setup in the US might enrage social conservatives there (especially since there is no age verification for tent rental).  But here in the Philippines, the conservatives seem to be more concerned with regulating public behavior rather than personal choices.  And in this sense, I find Filipino-style conservatism a more compassionate one.  As long as the visible part of society engages in "moral" acts, there is no cult of personality towards individuals who exercise personal choices in private, and who don't wish to act as an "example" to others.  It also goes along with a broader filipino  custom (which I also like), of not assuming the obvious.  Meaning, it is obvious the tents in the dance area may have been used for sex by the partygoers, but while American media would undoubtedly characterize this as a sex party for shock value, filipinos are very careful of not stating that which they have not personally witnessed or that which has no definite proof.  And this is another reason why I find filipino conservative side easy to digest by my libertarian digestive organs!

04 April 2009 @ 03:01 pm
For better or for worse it's over.  The barrage of exams that started in March has finally subsided, with results of it all unknown till third week of April.  Did I pass all my classes?  Will I be a full-fledged 2nd year med student next year?  I hope, but it's all a waiting game now.

The storm has left a big mess in my life and in my apartment.  The pile of unwashed dishes is undeniably smelly and i haven't had the strength of resolve yet to approach it.  The long overdue calls to my credit cards, and other financial matters are weighing on me.  I am planning out all the medical appointments that I've neglected due to my studies.  In a way, I miss caring just about the next day's exam.  Real life really isnt that exciting, but quite demanding anyway...

But at least i'll have more time to post here.  And catch everyone up on my controversial thoughts of the day.  Whoopie.
27 January 2009 @ 08:01 pm
How can death be both so common and so controversial?  it's an experience everyone has observed in others, and ultimately will undergo themselves.  In my case I knew it first from movies and books.  Its enormity, gravity, irrevocability only hit home for the first time about 6 or 7 years ago, when my dad's friend's wife passed away.  It was my first time in a funeral parlor. The idea of being next to a body that no longer contains the personality and will of a person that I used to admire and appreciate did not sit well with me.  It still doesn't.

A couple of years later my grandmother died.  I've been expecting her death since early childhood - she was a very sick woman.  I remember thinking every new year's eve that it would be her last.  But for years, she kept surviving and beating the odds.  So when she finally succumbed, I felt a strange mixture of relief for the end of her suffering, and surprise that this time she didn't cheat death.  How can something so inevitable be still so surprising?  It still surprises me, more than 5 years later, that I can't just call her up.  

To me death is final.  It is the ultimate undoing of a person - where not only does his subjective experience end, but also his will his desires his vision can no longer be asserted.  To me the aspect of being unable to affect the world around me is the scariest part of death.  Someone can attack people I love, walk all over my ideals, make mockery of my projects, my beliefs, break everything i've worked for my entire life - and there is nothing I can do about it.  Greatness or accomplishment matters little in death.  The will of the least deserving living will always trump the vision of the most deserving dead.  

Humans have long been inventing ways to circumvent this reality.  Life after death.  Reincarnation.  Separation of body and Soul.  Ghosts and parallel universes.  Like little children who close their eyes and pretend they are invisible, majority of humans preach  far fetched stories even when the truth is laying right before them.  Yes it's hard to let go.  But if death is universal and ultimately inevitable, why can't we just accept it for what it is, an end to life?  

Lives end but they are not erased.  Speaking of the dead in the present makes sense when their memory or affect on you is current.  Belief in a post-humous myth is not necessary.  Ron was the first to expect from me Visayan conversation.  He was not shy to address me in the local vernacular in class, knowing full well I had no idea what he was saying.  He threw down the Bisdak gauntlet to me, and I know he would have been proud of my progress if he had met me in recent days.  Or maybe he would have expected more of me.  Its not an answer I can get now.  Nor will I ever hear him play an instrument.  We were not close friends, and its a well-known side of him that I did not know, but I wish I did.

Doc told me that Ronnie describes me as someone who sees black and white with little gray in between.  Doc says Ron appreciates my directness.  If so, then I know I am not violating his will and his vision by neither aggrandizing nor belittling the degree of our interactions in 2007.  I hope he would have appreciated my honestly about death.  His death.  Ultimately, life-after-death mythology is to make it easier for some of the living.  But this post is for me, and I don't need a sugar coat.  And I have a feeling that neither does the one person I wish could read this entry, but never will.

I am lucky to have crossed paths with him.  And that crossing won't be forgotten.
03 November 2008 @ 06:51 pm
The blindfold was very tight, and pressed on my earlobes, making it not only impossible to see but also hard to hear.  Huddled in the jeepney with two other blindfolded souls, the others were barking orders at us as we assumed the most humble attitude possible.  Suddenly we heard a cry, "CHECKPOINT!! CHECKPOINT!!!".  A hand immediately forced the blindfold from my head, and a voice quietly instructed me, "hide it."  The policeman, clearly unaware of the happenings inside the jeepney, waved the driver to move on.  As we left the checkpoint, the blindfolds were again placed on our eyes. 

After an hour of driving on what felt like an empty road, I smelled salt in the air.  We were near the ocean, and soon enough the sounds of the waves crashing on a shore confirmed that theory.  The jeepney stopped, and with the blindfold on, I clumsily climbed out onto the sand.  I moved forward, but didn't know there were steps, and came tumbling down four steps onto a sandy shore.  It was 7PM.  The night of hell has begun, and at 7AM, multiple tortures later, the blindfold finally came off and I finally emerged...  A BROTHER IN THE COOLEST FRATERNITY OF MEDICAL STUDENTS ON EARTH!
02 October 2008 @ 01:53 am

Posting is a luxury.   Especially now, at 2AM, 5.5 hours before a quiz.    However, it's always the case - no time for anything.  Quizzes and exams are every day, and weekends are inadequate to keep up with reading.  I think the most important skill one learns in med school is just saying FUCK IT.  Yes, i could read more tonight.  But Id rather post.  SO THERE.

I ran into the dean the other day, and he told me, "I hear you're doing well."  I replied, "Only in medical school can barely passing be considered 'doing well'."  Its true, first bimonthly period I passed.  Barely.  And it won't happen this one.  No matter how hard I study, passing grades are elusive, especially in Anatomy.  Parasitology is not hard, but its time consuming, and although id love to pass it, im scared to devote more time to it than the absolute minimum.  I am struggling on the brink of passing and failing, and its been a gut wrenching experience.  Truth be told, failing a subject is unlikely to make my career lackluster.  If I failed something, Id stay an extra year.  I could take a lighter courseload for that year, and concentrate on USMLE I studies.  A superior USMLE score would offset a failing grade on my record.  Hence, nothing would be lost.  At the same time, the thought of a (50/50) possibility of staying here an extra year is not a pretty one.  I feel like Ill be an old man when I finally become someone.  Oh well, fuck it.

Aside from school i've been busy trying to enter a fraternity at my school.  It involves humiliating tasks, exhausting exercise, and mindboggling medicine quiz questions.  The latter helps me focus on my studies, the former two have left me quite tired every friday night.  Final rites will involve 16 hours of nonstop exercise both physical and mental.  An informal survey of upper years revealed a passing rate of about 50%.  I hope i can make it.

I cant wait till semester break... med school is no joke, y'all.

03 June 2008 @ 12:41 am

The hot and humid smog hit my face, and welcomed me back to Cebu.  "Welcomed back."  For the first time, im not "going there" but "coming back."  To be truthful I didn't miss it much.  To be honest, every part of my soul wanted to stay in NY.  I felt like all of my heart and half of my tears were not allowed to board the plane to the Philippines.  And yet, "im coming back."  Nothing is unfamiliar this time.  I brush aside the unmetered taxi peddlers (unmetered taxis at the airport charge unsuspecting visitors 3 to 4x the usual rate for a trip) with a casual, "Ang mas barato na magsakay ko ug Yellow Cab!" (It's cheaper that I will take a Yellow Cab - which is a type of collective jeepney, not really a taxi).  The peddler raises his eyebrows, "Uy! Kabalo ka nagbisaya!" (Wow! You speak Cebuano!) -- yeah, bitch that's right, Ayaw pagiyot ug Joe Amerkano - don't fuck with American Joe - well, I never said that, but that's what I was thinking as I made my way to the "yellow cab", and sat on the narrow bench with my luggage uncomfortably positioned between my legs.  13 US cents later, I was in the main transfer point where I ate lukewarm lugaw (rice congee with egg), and fixed my cell phone for $5.  

I took a metered taxi from the transfer point, as I was feeling tired, and soon I was walking toward my apartment, located in the part of Cebu where Province fights hard against the City and is (currently) winning the fight.  The sounds and smells of pig-sties, chained roosters next to houses, the tick-tocking of horses-and-buggies passing by next to jeepneys and motorcycles, the sight of one and two-story dirty wooden shacks centered around a busy market -- and of course the yelling of my neighbors "Amerkano is back!" reminded me, painfully, just how far away I am from the people and places that I love.  Once again, ill be the subject of amusement for the elderly, young, unemployed, and the tongue-itchy in my neighborhood.  Oh well, thats better than being the target of greed, dishonesty, and profit - the destiny of a foreigner who chooses to live in areas where he is not a novelty - that is, where other foreigners reside.  Thats pretty much the choice for foreigners in Cebu:  Be treated with very well hidden contempt, and screwed at every turn - or learn to adapt to some of the odd and shameless aspects of the provincial culture - including an absolute lack of concepts like privacy, minding your own business, and courteous silence.  Its a choice between the worst of cebu, and the weirdest - and I think i made the right choice of the latter.  Still, choosing it and loving it is not the same thing... 

And so the next morning, once again I wake at 5:30 AM to the roosters, to my neighbors bathing in the yard below my window, to the smell of fried eggs and longaniza and freshly cooked rice, to the yelling women and to the stalling engines of motorcycles..

Who cares, right?  Im here to study.  And for the last 2 weeks, i got back in the groove of reading, memorizing, notetaking, and taking life 5 textbook pages at a time.  Nabalik ko sa Sugbo, pero walay ko sa akong kasing-kasing dinhi.... pieces of my heart still remain in 201st street, and Topping avenue, and South street, and  Lanewood avenue...  i hope they are safe for the next 4 years.

I miss.

20 April 2008 @ 05:10 pm
Im haven't died.  Things happened too fast, and i didn't bother to post about them.  Here's a brief summary of things that occurred:

End of February:

1) I get really sick and arrive in Chong Hua ER with sharp pain.  I get pain meds that work and advice from the ER doc which was irrelevant to my actual condition, yet harmless in its execution. 
2)  Battery of tests in a search for the correct diagnosis.  Ultrasound results in Chong Hua were not correctly read (as determined by my US-based physician), but the mistakes were not glaring negligence - they were sort of in the ballpark of what COULD have caused my symptoms.
3)  CT scan at Perpetual was read by a radiologist that was either incompetent, high on drugs, or both. Some of his conclusions were so far-fetched and ludicrous (even to an uneducated eye like mine), it caused my (highly professional and educated) Chong Hua specialist  to shake his head, whereas my US-based doctor just laughed.
4)  I have to say that my specialist at Chong Hua (unlike the ER doc) was incredible.  Without the necessary tools OR experience in dealing with patients of my (not so common in Philippines) conditions, he correctly reinterpreted my radiology data, and gave me medicine that solved the problem.  At the same time, he lacked hubris and told me honestly that if I really want a clean bill of health I should go back to my US based doc.  When i did, the US doc said that my treatment was EXACTLY what he would have ordered himself.  By the way my Chong Hua doc did not charge me for appointments (I forced him to take money for my last visit).

My overall experience with healthcare in Cebu can be summarized as follows:  if your condition is not common in Philippines, you'll encounter a lot of idiots who would rather make false conclusions than admit their lack of knowledge.  At the same time there are competent, educated professionals, if you are lucky enough to find one.

March and April

Mom was crying on the phone and although I felt better, i decided to go back right away and get tested and treated in the US.  I missed finals, but it doesnt matter - since my undergraduate classes were for personal knowledge only.  Im still slated to start Southwestern University MHAM med school in June.

Aside from seeing family again, I was finally able to delight in foods that I've missed for so long, and are simply NOT available in Cebu.  Especially:

1) REAL bread, and real bagels (with lox!).
2) Good steak
3) Real mexican food (mole poblano, tacos al pastor, echiladas con salsa verde, and my other favorites)
4) New York City hot dogs!  (why do ALL hot dogs in Cebu taste like crap??)
5) Morir sonando (dominican drink of orange juice and condensed milk - mixed carefully over ice to prevent spontaneous milk protein denaturation).
6) Czech beer and specialty/premium beers
7) Chocolate covered Matzos!

Aside from stuffing myself and gaining (by my estimated calculations) 15lbs, I've also gotten to travel with my family to DC, Philly, and parts of Virginia.  It was a great feeling to get back in touch with American heritage, and to learn more about the revolutionary and civil wars. My favorite historical venues this trip were Colonial Williamsburg, VA; Smithsonian Native American museum in DC; and Confederate White House/museum in Richmond VA -- in that order.  I also spent the day at the Mutter medical museum, looking at birth defects, exceptional medical cases, and learning about topics like presidential healthcare and cojoined twin varieties.

What I haven't done this entire time is STUDY.  That's why im coming back to Cebu very soon... Because when i come back, I'll begin studying ahead for the coming year in earnest.  A preview worth a few chapters won't make a visible difference in my grade, but at least it will give me more familiarity when the subject rolls around.  I hope.  And I'm also planning to learn all body part names in Bisaya before the start of class.  That's my goal!

21 December 2007 @ 02:33 am
I've been here over 6 months already.

I've had boils on my ass, poop that smelled like a dead rat, ant and mosquito bites all over my legs, and high fever lasting a period greater than 3 days.  And im still ok.

I eat with spoon and fork together, or with my hands.

I abbreviate my speech to the point of lunacy, and my accent is slowly emerging as distinctly cebuano - as I put emphasis on the last syllable of any word, confuse my i with e, my o with my u, my b with my p with my v.... 

Aircon makes me shiver, and i actually call it "aircon" in my speech. 

Ive learned to see the world according to age and status, and from the respectful "sir" to the slightly diminutive "dong", i address each person according to their social standing. 

I know the value of the peso, and the way to conserve it.  The only time I think in dollars is when I pay tuition and realize that it's up by 10% thanks to the freefalling dollar exchange.  The other day i agreed to burn a cd for a friend's friend for 50 pesos. 

I am no longer capable of living a day without a hot, steaming plate of freshly cooked rice.  I know that not all rice tastes the same, and I can probably recognize by taste at least 3 of the 30+ major local types.

I've learned that honesty is being true to your word, not to your feelings; that form is often better than substance; that there is no such thing as a tree falling in a forest and a Cebuano not hearing about it; that an individual's worth, actions, and words mean nothing without a proper validation/interpretation/sanction by his society.  I may not agree with any of this, but i play by these rules, like everyone else.  And I don't confront anyone directly, even if im 100% right and they are 100% wrong.

I eat fish in every form: Dried, raw (Kin-ilaw), and I know that pork skin will give my blood vessels "the protective coating necessary to keep out harmful vitamins and nutrients" (line stolen from the Chris in the Philippines blog/website).

I look after the pressing of my shirts, the cutting of my nails, and other factors in personal grooming with the same zealousness as those around me. 

I am now comfortable talking about bodily functions in public.

So why the fuck are you still calling me Joe???  Pisti yawa inatay!! 
03 December 2007 @ 10:11 pm
Its been a rough and busy month, so I haven't posted much.  School got real hard, real fast.  Although i'm only taking three subjects - anatomy, histology, and bacteriology - it doesn't feel like a light work load.  In Anatomy we are already done with muscular, skeletal, and integumentary systems and surface anatomy.  In histology, we finished the cell, epithelia, and connective tissues.  In bacteriology, we are already done with history, morphology, structure, energy metabolism, life cycle, and genetics.  For metabolism and genetics we skipped over a LOT of specifics in the textbook.  In a way i am glad - I doubt the memorized pathways would last in my head until microbiology in second year med school.  Plus it allowed me to keep focus on the big picture and understanding of the overall factors.  

I missed 8 days of class due to a huge boil on my ass. Na'a ko matagtiki sa akong lubot - it sounds even funnier in Bisayan than in English!!!  Now dont knock me for skipping class - try sitting with your pants completely soaked with pus!  For treatment, I used the doctor prescribed cloxycillin antibiotic (supposedly specific for the staphylococcus bacteria in the boil), a topical antibiotic, as well as a local application of a Filipino leaf called "Buyo".  The latter produced immediate results - after application, the wound appeared softer, and cooler.

This week is preliminary exams.  The sequence of examinations in my school is Preliminaries-Midterms-Finals.  So the semester is roughly split into thirds.  Wish me luck... Im trying to stay focused.  But with my recent loss... its hard at times.  Cebu, my kitten died a few days ago.  I picked him up on the street only a few weeks ago - he was newborn, and totally abandoned.  Nursing him proved a bigger challenge than I expected, so a kind lady (who owns like 6 cats already) helped me a lot.  But for the last 2 weeks of his life he lived with me 100% of the time... In his short life, he proved his intelligence.  Litter box training was totally effortless.  In just 4 days i trained him not to touch the computer - he would walk around it and cuddle up against me when i was on it - but knew better than to jump on top.  He also learned to eat solid foods, but still loved the bottle for the attention.  His jumping skills reached the couch level, but not yet the table.  After a week long illness, he died.  Thats it.  Here are some memories of him.

28 October 2007 @ 05:50 am
Well I think I'm done posting about the trip.  Although after healing my feet in Manila, and meeting my friend from the states, we went onward to Boracay, there are few pictures and stories that I feel like posting.  Only thing I want to say about Boracay is you HAVE to try Paradise Grill there, especially the prawn soup... best food in the world.

Life back in Cebu has been fun for me.  I've been hanging out with a group of new friends, and its made things more fun than hacking it alone.  I also found a new place to live: an apartment with 2 tiny bedrooms for  the same rent cost as my current room.  Im trying to move now, but its hard.  Its the season for local elections, and everyone seems to be engaged in the process somehow.  I suppose we, Americans, would also be more engaged in local elections if they were truly LOCAL.  Here, the smallest unit of government, the Barangay, is composed of just 5-10 city blocks.  People usually know at least some of the candidates personally.  And of course the candidates do all they can to pull the unofficial strings of interpersonal relations to get elected.  Then again, good old fashioned vote buying is in the works also. In the neighborhood where I found the apartment, the candidate was giving away free donuts.  As I was sitting around with my new neighbors, I quickly turned the corny Bisaya joke "Donut, Bai?" which means, "Donut, dude?" but can also mean in english, "Do not buy!" into "Donut, Bai?  Vote!" or "Do not buy vote!".  My new neighbors laughed, some out of politeness.

On my way to post the remainder of my trip report, I passed by my favorite tapsilog place, and found it closed.  The sign on the door got me really confused, and here it is:
28 October 2007 @ 05:42 am
I woke up at 5:30Am, and summoned all my strength to get dressed and went outside. How I wished I could have a day of rest!! My body begged for it, but I had to meet my best friend in Manila on an arriving flight the next day. I had no idea how I could get back so fast, but I had to try.

It was early, but the entire village was up. There was smell of breakfast in the air, dogs and roosters and pigs making noise, kids running around… I decided not to bathe, since I could only imagine the water temperature after a night like the one I’ve had!! I used a soap towelette I brought with me to wash my hands and sat down to a breakfast which was exactly the same as the dinner minus the green beans. I was waiting to see if the man would bring up the issue of payment, but he never did. His hospitality was genuine, and I could tell he really liked my ways. Of course I left 80 pesos ($1.65) under my pillow in gratitude, but he wouldn’t know about that until I would have left the village.

As I was eating with him, I saw the older missionary lady from the night before talking in Tuali with a local on the steps above the man’s yard. Her tuali was quite good, and I correctly ascertained that she has lived in Cambulo for a while. So on the way out of the village, I smiled at her, and she said hello.

Sister D. turned out to be much cooler than my initial impression of her. Her way was very direct, unpatronizing, and genuine – and she didn’t try to switch every topic of conversation to god the way many religious representatives do. An American ex-pat, she left medical school in the US to join the mission in Cambulo, and lived there for over 35 years now. She asked me where I stayed, and grimaced when I told her. "Did he overcharge you?" she asked. "No, actually, he didn’t ask me to pay," I replied. The look of surprise on her face was not strong enough to cover her obvious disdain for the man. Then I remembered the "prayer" at dinner, and realized that there might be some bad blood there that runs deeper than I care to understand.

The house of sister D, unlike the native houses, was relatively private with her personal things hidden from public scrutiny. At the front steps of her door was a chained up baboon that growls at anyone who attempts to approach it. A baboon out of the zoo is a lot like a severely retired human individual with a criminal mind. In fact that’s the general impression I got from him. Sister D told me that the locals are very cruel to the baboon and like to throw things at him. I believe her, because even in cebu, I’ve seen people shamelessly throwing rocks at dogs. She also introduced me to an elder, who, when he found out I was trekking alone, asked me if I had a good walking cane. I told him I didn’t, and he came back shortly with a beautiful long one. That cane would later save my life twice, and I am so thankful I met this man.

Sister D walked me to the rice terraces that lead toward Batad, and stood there watching me as I attempted to walk on. Walking along the terraces is a tricky thing: Each step is essentially a pool of muddy water where the rice grows, and to step into one would mean getting wet up to the knee and getting stuck in sticky, slippery mud. The only dry land on a rice terrace is its rocky edge. The rocks are about 10" in width, with the watery/muddy terrace to one side, and a 5 meter fall to the next watery/muddy terrace step on the other. In short, if it weren’t for that walking cane the man gave me, I would have been in serious trouble.

All in all, the trail from Cambulo to Batad, and from Batad back to the main road to Banaue was far more challenging than the road from the previous day. Maybe I was already tired, or maybe there were more steep climbs.. But I can honestly say that I pushed myself beyond all limits that I thought I had.

Of course being a dumb ass that I am, I forgot to prepare for the journey. I forgot sunblock, and while the hike to Cambulo was mostly in the shade, from Cambulo to Batad I was exposed to the direct sun rays and quickly felt my skin get red… What were my options then? Walking back to cambulo over the scorching direct sun rays felt suicidal. So I just pressed onward, not letting myself rest any more in order to quickly get to batad, and hopefully, score some sunblock.

On the mountain overlooking batad, my strength finally gave out. My legs spasmed and refused to move. My body exhausted by sunburn and previous day’s journey refused to balance. So like a baby I went from step to step on my ass until I reached a little oasis a few meters above the village, where drinks were sold, and where was SHADE. I collapsed on the wooden bench there, and took long sips of their overpriced bottled water (I didn’t encounter any streams on the way to Batad), and didn’t care about anything else!

Two hours of rest did me a lot of good, and I felt strong enough to continue. As I rested I saw an American couple who shared some sunblock with me. They were with a local babysitter (guide) who was honestly pretty messed up looking. He gave them dirty looks, obviously anxious to get back to Banaue early enough to pick up another customer. I watched them intensely as they left to go back to the main road, since the trail from Batad back to Banaue is NOT obvious. In fact, the enterprising owner of the bottom part of the oasis structure wouldn’t give me directions, but instead tried hard to get me to hire him to SHOW me the 30 minute way to the trail for $11!!! This theme is so recurrent, the only people who are this way are the ones in the tourism business!

I watched very carefully as the American couple was lead away. There are few landmarks in the terraces, and not all are continuous (they are often separated by impassable gaps and elevations not seen from a distance).

 I thought I memorized pretty well the exact terrace levels they navigated, but I was wrong. I took a level 2 levels below the correct one, and soon ended up in a somewhat precarious situation. I could walk back and try to find the correct level, or there was a gap about a meter wide (and 20 meters deep!) that I would have to jump. What made the jump scary, was that the other side was about a meter higher than the one I was on. So in order to make it I would have to land on a tiny rock sticking out of the wall in front of me, before pulling myself up a meter to safety.

As I stood there contemplating my options, I saw an old man next to me. In his late 60s, wearing a "traditional" (key word for ancient/obsolete) native skirt-like garment for men, he asked me if I wanted to pose with him for pictures, for 10 pesos. I told him I was just trying to get to the road, and I don’t know if I can jump the gap. The man then took his walking stick, stuck it between the rocks of the wall across the gap, and using it for balance and precision support gracefully jumped on the small rock sticking out of the wall. He did it several times for illustration (and my personal humiliation), so at this point, going back was not an option for me. I took a deep breath and… well, im still here to write about it, aren’t I? 

The rest of the trail was less beautiful and far more grueling than anything before.   But i was used to many things already, and the infamous narrow bridge that was described in tourist literature didn't look so intimidating any more.

The last hour was by far the worst. There was a split in the trail with no clear demarcations. One was leading straight along the mountain ridge, but the other was a series of about 1000 high steps leading up to the very top. I was tempted to take the easier road when I heard what sounded like human sounds coming from the top. I took a chance… and climbed.

When I got to the top (called the Saddle), there was a group of men there wearing jeans, t-shirts, and guns. They had lots of rice and fish spread out on a long table and invited me to eat with them. Most were drunk, some were half sober. Turns out, they were an entire police unit from Baguio (another part of north Luzon) who were sent to work in Ifugao for 3 weeks, and they were spending their day off looking at the terraces. After having a meal, I accompanied them down a shortcut to the road. The sun already set and it was getting darker, so I was trying the best I could to rush down. The boys, aside from their police training, were natives of a different mountain province, and quite used to walking up and down mountain trails. But for me, darkness in the mountains felt like sure death. Just slipping on one of these steps could mean falling down the cliff. The police were quite understanding tho, and didn’t make too much fun of me on the way down. And they even helped carry my knapsack.

We got back to the road, and the private jeepney they hired was waiting for them there. There was not enough space inside, and I volunteered to join one of the policemen to ride on top of the jeepney. It’s a great experience and I recommend it to everyone. Just watch out for the tree branches!!!

We were slowed down near a mudslide area, 

but all in all got back to banaue by 6PM. I was stinky dirty and my foot sores were hurting so badly I had to pinch my tongue with my teeth to keep from making noises, but I went straight to the bus station and took the last bus out of Banaue to Solano.

In Solano, I stopped by the Solano City Lodge where the owner remembered me, and didn’t charge me a dime for using one of the rooms to shower and get myself in order (I left 40 pesos and some cookies there for her). She also sold me an 85 cent pair of flip flops since I was unable to get my shoes back on my broken down feet full of sores (I am NOT Maresyev!). I still had my walking cane on me, and it proved most useful in helping me walk to the bus stop, when every step sent painful stars to my otherwise clear vision. I grabbed the first bus to manila, and for the next 7 hours, I rested myself, treated my worst foot with antibiotic ointment, and thought about Sister D with respect and admiration.

28 October 2007 @ 05:10 am
By the time I went down the narrow treacherous steps to the village of Cambulo, dusk was setting. I saw an older white woman walk by (missionary, I was told) who gave me a look full of mistrust, and I didn’t bother talking to her at that time. I went to the only hotel of the town, and almost agreed to lodge there for $2.25 before the female hotel owner with shifty little eyes attempted to sell me bottled water for $1.50! It was an insult to my intelligence – natural mountain spring water is safe to drink fresh, according to some, and most certainly safe after boiling. Selling bottled water there (especially at such a high cost!) was taking advantage, and renewed my mistrust of the tourist industry in Ifugao. I declined to lodge there, lest something else becomes "missing" from my bookbag again. 

Walking through the native village is a bit strange for a westerner used to personal space and clear property ownership demarcations. There is no "front street", just a bunch of alleyways, and narrow steps leading behind various houses and shacks, with barking dogs jumping out at you, with locals going about their business with little concern for privacy, with chickens freely walking between various houses with no way to tell which house owns which chicken. According to one person, the chicken that’s yours is the one that always comes back to you asking for food. 

And so I walked through the village until I nearly stumbled in the semi-darkness over a drunk man sleeping next to a wall. He woke up and started chatting with me. I don’t know what he was saying  – he freely mixed English with Tagalog with Tuali (one of the three related dialects of the Ifugao). I told him in very bad Tuali that I need a place to stay and some food (which exhausted about 30% of what I memorized while walking alone on the trail). I think that was the first thing I said that he actually understood and he began talking even faster. I was slowly getting used to his speech and was able to make out some of the broken English components of his sentences.

The man’s yard was composed of a central native hut – a straw covered wooden box positioned on long legs – about 2.5 meters tall in all. The first 1.25 meters off the ground are wooden supports, with empty space under the house, and to the side there is a ladder leading up to the house which is nothing more than a sleeping space with no way to stand up and stretch. In 1.25m high space under the house the wife of the man made a fire, and began cooking food. Away from the native house was a narrow stretch of rock (over a somewhat uncomfortable cliff of about 2 meters with a nice hard rock bed underneath), leading to another platform with a second, "modern" house on it. This one is taller and wider than the native box, and also stands on long wooden legs. The living space on top is made of tin walls and roof, with wooden structure support, and has two tiny rooms inside, which are tall enough for you to walk upright in. Under the house there is a tall boulder next to a cliff. That’s the "bathroom".

If you are all tired of reading these descriptions, im frigging tired of writing them. My camera ran out of batteries, and I could only take two shots of Cambulo. There were no batteries in the village to buy. So I guess 1000 words are needed to make up for the lack of pictures…

Finally the food was ready, and the man invited me to eat. The wife, the (daughter? Niece? Helper?) and another woman waited on the sidelines while the man and I were eating. I don’t know why it was this way – there was plenty of food for everyone. But at breakfast also, the women ate separately, so perhaps, such is their tradition. He and I sat down, and with expression full of fake awe and mockery he began making grandiose gestures saying something akin to, "Blah blah blah blah thank you jesus thank you jesus. Blah blah blah blah thank you jesus thank you jesus." I sat there, smiling politely. My gut feeling told me that he was really as fake as he sounded, but I did not dare to make my observations obvious. Finally, the man saw that I was smiling, yet had no intention to pray, so he stopped and grabbed a plate.

There is nothing more tasty than freshly gathered rice cooked in a pot over a real fire!!! There would have been no need for other food – the rice alone felt like a treat. Also, I haven’t eaten since 8am, and it was the first time I realized how hungry I was! On top of the rice we placed some lentils and green beans, and on the side were some potatoes (first place in the Philippines where I’ve seen potatoes popular and available). I summoned my self-control and made sure to eat no more than what the man ate. I also left just a little rice on the plate as a sign that I was already full. The man was surprised, in the broken English I understood that his past experience with tourists is that they eat plenty.

Then I took out the remaining half bottle of red wine that I bought in Manila, and I saw the fascination on the man’s face. He’s never seen such a pretty bottle before!! He loved the taste also, and kept telling me how good it is! I don’t know if it was really his first time tasting grape wine, but chances are, if he did taste it before, it was the really bad tasting Filipino one, not the Australian import that I carried.

The man asked me where I want to stay – in the native house, or the "modern" one. I told him that ill stay wherever is convenient for him, and I don’t want to be an intrusion. He started another long speech, the gist of which was, that he is so happy that he now got to build a nice comfortable modern house, but these nitwit tourists are always trying to offer him money for the experience of sleeping in a native hut. So if I want to be like them, he doesn’t mind, he is happy to share his native hut so I can try sleeping in one! I made it clear that Ill sleep anywhere, and I just need sleep – and I think I got as much respect from him for that, as I did earlier when I didn’t pray.

It was pitch black outside and I nearly fell off the 2 meter high ridge as I headed towards the modern house for the night. My feet were aching and full of sores, my legs were tight with exhaustion, and I barely made it up the steps of the house to collapse on the carpet laid out for me on the floor of one of the rooms. Blankets were prepared, but I found them insufficient to shield me from the cold of the mountain night. In a country where temperature rarely falls below 75, I found myself in the low 50s, with nothing but a t-shirt on! I put on 2 more t-shirts and laid there shaking under a thin blanket and fell asleep.

28 October 2007 @ 04:42 am

My itinerary was planned as follows: I would catch a ride down the main road from Banaue to Mayuyao and get off at a place from which I can hike to the village of Cambulo. According to my guide book this would have been a 4 hour walk. I would spend the night there, and then walk to Batad in the morning, and from Batad, back to Banaue (2.5 hours according to the guide book). The hour values turned out to be somewhat underestimated, and the hardship of the trail severely understated. By the way, the reason for my wanting to stay in Cambulo was that Batad is a major tourist destination, while only a few hike as far as Cambulo. I've had enough of the tourism industry in Banaue to risk staying the night in a similar place!

So at 9AM, after getting back to the hotel and lamenting the missing phone, I went outside and sat on the curb, waiting for the 11AM bus going in the direction of Mayuyao. The trike drivers did their best to get me to ride with them. The actual price for riding a trike alone for a few kilometers is 100 pesos, but filipinos often wait for more passengers to show up so they can share the cost. In the case of tourists, however, the quoted prices for riding alone range from 250 to 400 pesos. One thing I found hillarious about the way the trike drivers offered their services was their (quite accurate, in my opinion) perception of western mentality. Their sales pitch to me was, "Dont you want to go there RIGHT NOW?" In a place where nothing is done immediately or right away, urgency can be a great selling commodity. Its understandable why most western tourists visiting Banaue might rush - the week or two of vacation can't be wasted waiting for buses and all, and what's an extra 5 bucks compared to the cost of an airplane ticket? But many filipinos I've met truly believe that westerners are like that in their every day life: always rushing, always on a deadline, etc. I guess hollywood movies contribute to that also. 

So I digress. I'm sitting there waiting, and finally one trike driver decides to make friends with me. He sat down next to me, and began asking me where im from, etc. As he was talking, I noticed his gums and teeth were bright red. In fact, everyone i met in Banaue had what I thought was a bad case of scurvy. Turns out, the redness is not blood, but betel nut juice. I asked him if I could try some, and with his patient coaching, I chewed a nut and experienced a sensation of mild euphoria, warmth, and elevation of spirits - not unlike a glass of really good wine. Best thing about the betel nut is that its legal in all countries, including the US (as long as it imported in the whole, unprocessed form).


How to chew a betel nut:

The art of betel nut chewing involves putting the right ingredients into your mouth at the right time, and avoiding swallowing anything at any time. You start by putting the actual nut into your mouth, and chewing it until it feel soft and malleable in the mouth. Then, the leaves (which according to wikipedia come from the betel pepper plant, unrelated to the betel nut tree) are added, and the whole mixture is chewed, while excess saliva is spat. Finally, the most important ingredient, lime (white powder derived from limestone, i think it's some kind of oxidizing agent) is carefully added pinch by pinch on top of the nut and leaf mixture in the mouth, while care is taken not to let any of the powder touch the mucosa of your mouth first. The powder reacts with the betel mixture and turns the juice bright red. Apparently, this process extracts the psychoactive ingredients, and it is at this point you feel the "high". After spitting out the excess red juice, and chewing for a while, one adds a bit of tobacco leaf to the mixture which contributes to the subjective high as well.


So we chewed betel nut for a while, then the trike driver told me his grandmother is going to her place not far from the Cambulo trail, and he agrees to take me there for 50 pesos. Reluctantly, i agreed: I really wanted to start my journey, and the fact that he agreed to the actual price made me trust him a little bit. I was so wrong!!

When his grandmother got off, we took some pictures

and went on our way. The road is very rough and trike shakes very violently as it goes over the rocky road up the mountain. Finally, the trike driver tells me we've arrived, and points to the long, narrow steps up the face of a mountain. He asks me for the 50th time if Im sure I don't want to hire him as a guide, but I thanked him and went on my way. The climb was quite tiring, but 300 steps later I was at a fork in the road with no idea which way to go. I went left first, but 15 minutes later encountered a local who adamantly insisted that this was NOT the way to Cambulo. I went back and took the right fork, and shortly ended up at a small wooden house with no apparent trail leading further.

"Ayoh!" I called, and suddenly I saw an old lady appear from the tall grass in the steep cliff leading down the face of the mountain. She didn't speak much english, but understood that I was going to Cambulo. WRONG WAY! I was told. Then she explained that if I take a short cut through her rice terrace fields, i will get to the main road faster than back tracking. She began quickly bouncing from rock to rock leading me down the treacherous path down the face of the mountain to her rice terraces, and then then down the terraces toward the road. I was quite embarrassed since it took me painfully long to follow her without losing my balance, and then i even fell twice, and at one particularly high step, i had to sit and slide on my ass like a baby. She had a blast watching me, and didn't hide her amusement at my feeble efforts. At the end, i was full with gratitude to her for showing me a quicker path and saving me almost an hour, and gave her the dried mango pack I had in my bookbag as a snack. This is the face of the mountain that i came down from:

And so I ended up on the same road the trike driver let me off on, but further up, and continued walking towards Mayuyao, cursing him for not taking me all the way to my destination. Did he do it on purpose, to make it back to Banaue quicker? Or did he make a genuine mistake and let me off at the wrong path innocently? The point is that after 45 minutes of walking in the scorching sun, I finally came to a big sign, "Cambulo Elementary", and a wide path leading into the mountain that looks nothing like the narrow fungus covered steps the trike driver showed me.

The dirt road quickly narrowed, and became quite steep. As an inexperienced hiker, i began running out of strength and breath in the first hour. To help myself with the climb, i broke off a sturdy stick from a dead tree, and used it to prop myself up with every step. About 90 minutes later I was walking down a narrow trail along the top of the mountain, with a cliff several meters deep just a foot away from my foot!! To the other side was a steep mountain face which i relied on at times for balance. Along the way, I encountered evidence of recent mud slides, two of which completely blocked the road, and I had to climb over. I also saw gorgeous waterfalls, all of which i had to cross. 

Although the locals do it almost every day, for me it felt suicidal to step into a fast running waterfall stream that rushes towards the cliff on a trail that's narrower than my shoulders. 

Still, there was little choice, and having wasted 3 hours and having been exhausted by the wrong way detour (courtesy of the trike driver), I knew I had to hurry. I would surely not survive on the trail in the dark...

No matter what the danger, the scenery was absolutely breathtaking. 

I tried taking pictures, but truly, nothing compares to the panoramic scene that opened up whenever i turned the corner to the other face of some mountain. The mountain ranges, the beautiful rice terraces carved like giant green steps into the face of each mountain, the gorgeous trees along the way.. it was breathtaking.

Along the way, I also got to see some exotic butterflies. One, for instance, looks like the head of a fish when it closes its wings. Another is charcoal black, with 3 bright circular spots running down its wings.

As I entered deeper into Ifugao province country, I met locals on the trail. Farmers with giant 100lb bags on their heads, hunters with a 20" machete hanging on their side, and a rifle on the shoulder, as well as some guides heading back to Banaue. Because I was such a slow walker, some locals caught up with me from behind. These three were teachers from Cambulo Elementary, going home for the weekend. 

They slowed down to my pace, and I attempted to speed up to theirs, and we continued onward. Im glad we met – they showed me the proper way to cross streams, to walk over mudslides, to use my walking stick (which they said was inadequate) and to navigated the extra narrow cliffhanging parts of the trail. I asked them if anyone ever fell from one of those, and the answer was, "oh, last week, from that one. But he was drunk anyway."

We kept walking, and the beautiful rice terraces finally opened up in the scenery below the cliff along which we walked.

One could also see tiny villages scattered along mountain faces.  Although they look deceptively close, it would take much longer to walk from one to the other.  The direct path is often impossible.

We took a short rest stop above Cambulo, where I took some pictures, and observed a local chopping up firewood

before bringing it down to the village of CAMBULO:

19 October 2007 @ 03:57 am
From Solano, I continued onto Banaue, the site of the first (and least impressive) rice terraces in Ifugao. I went there via Jeepney, with a quick transfer at Lagawi, it took me about 2.5 hours to get to Banaue. it was in the jeepney that things first started getting a little weird. Like always, I chatted up a local to try to find out where to stay, where to get off, and how to move on. However, that particular lady in her 40s seemed rather peculiar in her answers. She avoided any specific advice or giving any information relating to transportation out of Banaue. However, she stressed about 20 times the importance of registering with the Tourist Information Office. There was something very odd about the way she was saying it, and I decided to myself that she or a family member works there. I was wrong.

When I got to Banaue, it disappointed me right away as an obvious tourist trap. The mountain top plaza where jeepneys stop is surrounded by hotels, restaurants with tourist pricing, and about a gazillion trike drives immediately offering lift service to the major hiking trails. I checked into a hotel room worth 150 pesos (3 dollars) which I negotiated down to 100 (aren’t I a bastard?), taking advantage of the slow season. Best thing about the hotel was the view from the common balcony (private rooms with this view are available at a higher rate).

The restaurant below the hotel was serving food at nearly the cost of my room, so I went down to a small market there, and for about a buck had native chicken soup with rice (native chickens run around freely, are cooked with hair still on the skin, with almost no spices, and taste really delicious!).

It was getting dark and I was hoping to encounter some sort of native bar where I could chat up some locals. The reason for my desperation was that the few strangers I spoke with on the street were as weird as the lady on the jeepney, babbling on about the Tourist Information Office (TIO) (which at this point I decided I would NOT visit), and showing very little of the Filipino helpfulness and knowledge of their locality that I’ve come to appreciate here.

The bars near the plaza were all tourist oriented, so I decided to walk in down the road leading off the mountain into the local residential area where there are no bars whatsoever, according to one of the locals who also sent me TIO. Surely enough I encounter a group of drunk kids ranging in age from about 15 to 18. I asked them where the booze is, and they took me in the same direction to a row of native bars. One is permanently closed because of a stabbing that occurred 5 months ago, the other two were still functioning. Both had their doors closed at 10:15PM but we knocked and were let inside. After a few beers with my underaged drinking friends (hey, they were drinking already, my conscience is clean!), they finally spilled the beans on what was happening with the TIO mafia. I don’t know if I should believe everything they said, but it was the first thing I heard in Banaue that made some sort of sense to me.

Apparently, it was here in Ifugao that the peacecorps volunteer Campbell was murdered. I remember following the story last year, and even visiting her blog (this amazing woman had a heart bigger than life.. http://juliainthephilippines.blogspot.com/). After the death, local authorities came under serious pressure from to ensure tourist safety. As a result, the locals are now being pressured to NOT advice foreigners on anything, but to only direct them to the TIO. The locals are told that should anything happen to the foreigner after talking to them, they would be held accountable. While such a threat would be laughable and unenforceable in the states, in the Philippines where image is everything, and where what others do and say is everyone's business – this was taken quite seriously.

Furthermore, the local government of Banaue made a ruling that all night life must seize at 10PM. Of course the way it really works is that the bars appear closed at 10, but Filipinos continue drinking inside. The locals are encouraged to herd the foreigners to bed after dark, and after I said goodbye to the kids and got back up the mountain, at least 5 filipinos came up to me, “where are you staying? You should go home now, its late, there is nothing here any more”. I knocked on a few more “closed” bar doors (one of them had music and a crowd of people inside, and the bouncer adamantly insisted they were closed already!) and I was finally let inside one (which shall remain nameless for the protection of the owner who let me pass). Inside, it was full of people, and I chatted up the owner who basically confirmed everything the kids had told me. I was the only foreigner inside the bar, and the tables were full of rather roudy male and female Filipinos. Two were having a heated debate and waving fists at each other!! This was definitely not the docile and friendly cebuano drinking atmosphere with everyone doing “tagay’s”, taking turns sharing the same drinking glass. I was in a different land now…There was also a large sign at the bar, “No male to male dancing”. Again, a far cry from the laissez faire cebuano attitude towards homosexuality.

The real closing was at 1:00AM, and I went around the corner to my hotel to find the metal gate shut and padlocked from the inside!! I knocked for about 5 minutes when the sleeping face of the hotel (owner?) finally appeared. “You are disturbing the peace” I was told!!!!!!! I understand her position, I was probably the only “problem” foreigner in the hotel who didn’t want to be herded to bed at 10PM. I told her that I paid for my room and wasn’t informed of any lock out policies, and that I’ll never stay in her hotel again. That satisfied her immensely, and surely enough, while I went out for breakfast in the morning, my $10 nokia spare cell phone inside my luggage was snatched. I am SURE it happened then and there, but alas, no proof.

For breakfast I went down the mountain again, but this time using the shortcut that the kids showed me the night before, the same one I took home. I almost crapped my pants when I saw that shortcut in the daytime!!! 
The long narrow drawbridge

 over a fast and rocky river, 

and the 150 or so steps leading up the mountain face afterwards are not something one should attempt in pitch-black darkness with red horse beer splashing around in the belly.

After walking for a while, I came upon a store selling freshly made Malakit – the local rice that is ground together with sweet potato, then wrapped in banana leaf and cooked.  On the way to the store, I saw some women engaged in this activity:

Two malakit that I ate for 20 cents were more than enough to fill me. At 8AM, this would be my last meal for the next 12 hours of a grueling yet exciting journey…

17 October 2007 @ 07:43 am

I stayed in Manila one night, and in the morning, I started my journey toward the Ifugao rice terraces, the 8th wonder of the world.

During my transfer in Cabanatuan, I had unpleasant experiences. Apparently, too many tourists pass by this main transportation hub, and for me, tourist places are the least safe from trouble. I was waiting for a jeepney from the bus terminal to the main road, where I could hitchhike a bus going on towards Ifugao. A trike driver (trikes are motorcycles with a passenger car attached to the side) apparently decided that by insisting that I take a ride with him (more expensive than jeepney) he will increase the chances of my giving in. I stood firm, and (I admit it was very hot), without thinking, I finally told him in a very simple phrase, “Jeepney na lang” which means, “just a jeepney.” I have no idea if he was offended that a jeepney was a better form of transportation, or whether he detected from the way I said it that I was learning Visayan, and not Tagalog (tagalog speakers look down on the Visayas), but the point is he went ballistic on me in his language waving his fist in the air, before driving off.

After that incident, I got to the main road via jeepney, and had the most annoying experience of a child beggar molesting me the entire time I waited for the bus (20+ minutes). Now I don’t know enough about the child to know if he was really in need, or simply told by his “loving” parents to collect money from foreigners as a supplemental family income. But the 20+ minutes of standing there, as he yelled “give me peso!!” and pulled on my clothes and tried to grab my hand convinced me that not giving anything to him was probably the right decision. Lucky for me a local lady came to my rescue and yelled at the kid.

Once again, I felt my lack of knowledge of tagalog work against me. In general, such kids target tourists because they are the ones most easily intimidated by such public displays. Also, a tourist is less likely to distinguish true abject poverty from the lucrative business of foreigner begging (by the way, the truly malnourished and impoverished Filipinos I’ve seen in squatter areas and underserved provinces are too proud to beg.. and there was not a single beggar in the remote Ifugao village of cambulo where living conditions are far beyond mere hardship). The most a Filipino would give such a child is a couple of pesos. A tourist thinking in euros or dollars might give 50 or 100. Anyway, in cebu, I tell the kid to leave me alone in Visayan, and that quickly makes them lose interest. But in Luzon I was just a helpless tourist, and an English speaking target. I was SO glad to get out of Cabanatuan when the bus arrived. 

It was still light when my bus arrived in the small town of Solano in Nueva Viscaya province. This place is clearly not a tourist destination, which is one of the reasons I decided to spend the night at the Solano Lodge (highly recommend it, the lady owner is an incredibly nice person). The night life here did not disappoint me. Although nearly all of Philippines appears to be enamored with cheesy 80s style elevator music and local style pop that I haven’t yet learned to appreciate (but starting to), Solano was clearly a rocker town. I had a great time bar hopping, listening to live bands play famous English-language rock ballads and, on occasion, things that appeared to be original.

Best thing about being in a such a bar in Solano is that I was able to forget for a while that I am in Philippines, and I imagined myself back in Mexico. It was easy to do – the people in Nueva Viscaya seem to a tougher bunch than Cebuanos and the Manila city folk. For the first time, I did not hear the colonial-style sweetly-insincere “SIR!!! How can I help you SIR!!” thrown towards me by bartenders and such. Maybe I didn’t stay there long enough, but everyone in Solano appeared proud, and not willing to lick the boots of any foreigner. In short, I felt accepted as a person. Eventually I made friends with two trike drivers on their day off, and accompanied them as they went barhopping. The last bar was karaoke, and being already drunk I enjoyed torturing the patrons with my voice at 5 pesos per song, while one of my companions tried in vain to kiss the bar girl for whom he bought an overpriced drink (like in Mexico, buying bar girls drinks costs more). In the end, he got nowhere with her (just a little peck, then she wounded his ego by telling him that the only person she would kiss at the table is ME – spoken in english for my benefit) while I had a good time singing and watching him make an ass out of himself!

12 October 2007 @ 04:05 am

This will be the first of a series of memories from my recent trip to North Luzon and Boracay.  Hope its not too boring.  I'll try to add pictures whenever I can, and not all at once, so keep checking back for more:)

Here it goes....

The boat from Cebu to Manila was pleasant and cheap – a better option than flying if you are not in a hurry. For 20 US dollars (under 1000 pesos) I got myself a bed in an airconditioned hall with about 100 beds in it. It wasn’t cramped, and the temperature was just right. The boat itself is a cruise ship with full amenities – gym, karaoke, swimming pool, disco at night, and a 24 hour snack and beer bar. The 2 complimentary meals were very basic. The breakfast was way too salty (my Filipino companions loved it), lunch was fairly decent. The bacon and rice lovingly wrapped in foil for me by Ate Betty kept me full throughout the trip.

The best part of traveling by boat for me was the social aspect. Being stuck together on a ship allowed me to quickly get close with my bunkmates, although as I had expected, neither I nor they chose to pursue the friendship upon disembarking, beyond cell phone texting. Something so pointless and yet so satisfying about a passionate debate about the meaning of life, love, and other matters neither of us was really qualified enough to discuss! We drank my bottle of tanduay rhum and their emperador whiskey, chasing each shot with sweet mango juice and spoke English visaya and ilocano for the benefit of all parties present. In the end, friendship knew no language barriers.

I also got some insight into Filipino culture and its distinction from mine. Before I met my friends, I was wandering the halls of the ship aimlessly, and found a disco. The bouncer told me the disco runs from 9pm till midnight. He encouraged me to enter, “only 20 pesos sir! Please come in, enjoy yourself!” It was only 10pm so I decided to come back later. I met my friends and around 10:45 all of us came back to the disco. The change in the face of the bouncer was obvious: apparently his job was to help attract foreign men and hot Filipinas, not a group of (not yet drunk) Filipinos from such lucrative fields as iron welding and security!! He made it clear to the group that I can come in if I wish, but for the rest, “it’s really late, the disco is closing in an hour, and its not a good use of your 20 pesos”. 

At that moment, I thought there would be trouble. I remembered the day Dima and I were refused at a bar in the West Village on bullshit grounds, and how we made trouble after that (kicking the door, being roughed up by security, ah, the good old days!). That’s why I was amazed when my friends simply said ok, and retreated. Were they really not offended?

It was then that Max (the iron welder) lit up a cigarette and took a long drag right under the NO SMOKING sign outside the disco. The others followed suit, and took care to ash on the floor. Nobody mentioned the incident that happened, the appearance was made that everyone suddenly wanted to smoke and couldn’t walk 50 meters to the smoking area outside. 

Perhaps its all silly. In the end its not the disco bouncer or the boat management, but the janitor who would have to clean it all. But coming from a culture where confrontation, self-assertion, and direct engagement are a way of life, it was an interesting thing for me to observe.

08 October 2007 @ 01:38 am
I am still reluctant to post about my travels.  I dont know how to describe everything in such a way that the reader will feel what I feel.  I mean, i want to explain the things that made me happiest, and the things that made me angriest...  ok give me time, i will try at some point.

Today was a good sunday.  I woke up at 11AM to the barking of the neighbors' dog and the smell of vegetable saute.  They invited me to have lunch with them, and that was my breakfast.  Afterwards, i walked across the street to a neighbor's house where we watched Manny Pacquiao beat Antonio Barreras..  There were about 5 of us watching the fight.  For me, boxing is really an important component of fitting in here... after all, I really don't have much in common with filipinos.  Im a lousy singer, i don't believe in God, and I don't care for basketball - in other words, i lack the three most important attributes of a filipino!  However, people here love boxing, and so do I, so we connect on that.  The fact that I look like Freddie Roach, Manny Pacquiao's trainer (thats why i picked his picture for my profile), also helps in that.

The rest of the day was spent taking care of things.  I helped Ate Joy figure out her cell phone functions, and she went with me to see the new apartment that I want to rent.  Its night now, and i can't sleep.  But on my way to the internet cafe to post this meaningless note, i some neighbors playing guitar on the street... i joined them for about an hour, just listening, singing, while looking at the cloudy sky and the moon shining through the fog onto the rooftops...

class starts October 29th.  Till then, im just enjoying life as it comes.
04 October 2007 @ 12:59 am
No, I am not dead.  With everything that happened, took me a while to make a post.  Without beating around the bush:  I withdrew from CIM for reasons previously discussed.  It was a painful decision, full of what ifs.  The truth is, if i kept struggling, there is a good chance I might have even passed the year.  But what then?  Is studying medicine really about passing, or about getting the best understanding possible?  I know ill learn more with lecture. The financial loss is not as significant (by American standards) as the time lost...  but I've gained a preview of medical coursework that will help me focus in the future.  I also know what I'm lacking compared to my Filipino classmates.  So, new game plan:

1)  Second semester I will take Anatomy, Histology, and Microbiology with Parasitology on an undergraduate level.  Most med students here have had these subjects, and I want the same familiarity when i start medical school again.
2)  June I start medical school in Southwestern or University of Visayas (90% chance the first one) where I will get lectures, better lab equipment, more guidance, and hopefully a better UNDERSTANDING.  

Stay tuned for my travel adventures....:)

I just wanted to clarify my disappointments... I don't believe that CIM is a bad school.  It's a great school, mostly owing to the amazing students they tend to draw.  All I am saying is that I could be learning so much more if we had lecture.  PBL appears to me to be a system catering to the extremely well prepared, or the genius-level IQ.  For the rest of us... it would be nice to have a smart person digest a few things for us first, before we delve into the literature.  I AM learning.  I AM NOT DOING SO BAD, at least according to class rank.  But I could be doing BETTER.  And that's my point...

30 July 2007 @ 12:46 pm
Its hard to admit you are wrong, especially publicly.  But at the risk of confirming myself to be a flake, i will hereby say: the choice of medical school that I made was not the best for me.  Keyword here is for ME.  CIM is a really good school because: 1) I love all the professors I've met there except one, 2) The student body is composed of truly amazing, dedicated, brilliant individuals, and 3)  I think they are doing the best anyone can with the PBL model.

So what is the mistake?  The mistake was choosing PBL.  PBL is great, but not great for ME.  Let me explain the PBL process:
1)  Students meet to discuss a new topic.  We brainstorm for about 2 or 2.5 hours the various aspects of the new topic that we should study.  We then get a checklist of topics that we should actually study, and a reading assignment (sometimes from a book that is no longer in print, and then it is the students responsibility to hunt for it/copy it at the library, or use unspecified other books for his or her education).
2)  We meet the next day and discuss what we had read in detail.  The facilitator is silent and only interrupts if someone is wrong, or if we missed an issue or topic.  
3)  On rare occasions (3 hours a week or so?) we get crash-lectures on specific topics or an exam review.  Its not comprehensive, more like an overview than a real lecture.

Why I thought PBL would be a great way to learn for ME:
1) I thought that by having more time to read, I would be able to learn more.  i usually find most lecturers too slow, and i thought that at my own pace I would learn more, faster.
2) Integration of subjects by topic.  I thought that studying one system at a time from different aspects (biochemical, histological, physiological, etc) would give me a deeper understanding of the topics at hand.
3) With CIM in particular, I attributed their excellent board passing rate to their teaching ability.

Why I was wrong:
1) i assumed that I would be able to draw all the necessary conclusions, make all the necessary connections,  and fully understand what I was reading.  I am not sure if it's medical literature in general, or our books in particular, but understanding has been a partly elusive challenge.  Sometimes I remember the details, sometimes I dont.  but before the exam, I really don't have an understanding of what is more important, and what is less important.  Is it my fault?  perhaps.  Although i really (honestly!) am studying long hours and with full effort, i only know what I know.  And without looking ahead, some things may seem trivial now, and become crucial in later sections.  What I miss is the professor's guidance.  What i miss is emphasis.  What I miss is organisation.  What I miss is an accomplished mind helping young innocent minds see things in a better, more logical, or more useful way.  Rediscovering the wheel is fun too, but not helpful when there is so much yet to be learned in a short time...

2)  Integration of subject by topic didn't bring the additional layer of understanding to me.  The questions on the combined exam are not integrated between books.  In other words, some questions will ONLY ask about histo, others will ONLY ask about biochem.  Again, there are no lectures, and its up to the student to draw the structure-function parallels between the disciplines.  Sometimes I can, other times I miss it.  But I know that in a lecture setting i would get a lot more understanding.

3)  One should not under-appreciate the benefits of high expectations.  In that sense, CIM is a great institution.  But a lot of the students there are already... learned.  A good portion of the class went to Velez for undergraduate.  i hear them studying at the coffee shop sometimes, and they are talking (more shallowly) about the SAME THINGS THAT WE ARE STUDYING NOW.  While for me, cartillage was not a specially emphasized topic in undergrad bio, these kids already know the 12 types, where it is found, and general characteristics.  Of course med school is WAY deeper than med tech program.  But when it comes to PBL, having a background makes a HUGE difference.  You are able to at least roughly place all new information into previously learned categories.  The big issues are review, the learning is only at the detail level.  Now take someone whose pre-med included just the bare minimum: someone like me.  I got overwhelmed with the level of detail, and missed out on a lot of the big picture issues (that could have been elucidated in lecture...).

In short here is my opinion, subject to change as further facts come in:
If your background is strong, if you've had prior exposure to Anatomy, Histo, and Biochem, then PBL is a fantastic way to learn because it allows you to go deep, to practice talking about it with your classmates, and gives you a greater flexibility of study schedule than set lecture times.
However, if your pre-med is only basic, then many key concepts and connections will be lost in the self-study...err.. PBL method.  The amount of information will be overwhelming.  Medical school is not meant to be easy - and every free moment should be spent learning.  But without either the guidance of a professor, or previous preparatory knowledge to help organize issues and topics, the time spent organizing and placing information in its proper place will take away from studying.  

oh well, no use crying over spilled milk.  Have to make best with what i have.  But all you jokers who love to skip out on lecture in your schools - you are taking for granted what I have learned the hard way is a true priveledge and benefit!  And yes, I was a joker also.  Until now.
Posting here has been long overdue.  For a few days my mind has been in California for certain private reasons, and the thoughts weren't happy.  When Dr. S.S., a white doctor in NY who also got his degree in the Philippines told me that the hardest thing about studying here is not being there for your loved ones, i didn't take him seriously.  Now I am realizing that he is right.  I've been feeling the distance with every collagen fiber in my body.   "Life goes on" is an overly simplistic statement.  It does, but our saddest and happiest moments never stay in the past, but become a part of us, and change us.  For me, this sad period served as a motivation to study more, because some day, that knowledge could prevent sadness for many others.  I hope.  And yes, I finally passed an exam.  Although half the class passed also, i am glad to be in the top half again.

Since I last posted, many things have happened, but recalling them in detail is hard.  Every day brings so much novelty, it all blends together and forms this general sense of.... a strong desire for normalcy!  Maybe that's why I've been spending more money this week, seeking out food and environment that remind me of home.  Studying at Starbucks, ordering cream cheese bagels and pasta dishes - these are all specialty / luxury items here.  But I needed it, to feel sane again.

One thing that makes it easier being here, is that Cebu reminds me of the Soviet Union in many many ways.  From old soviet flicks to my own childhood memories, many things here serve as nostalgia triggers.  Especially weekend nights, when I walk and see groups of friends drinking on the steps of houses..  Sometimes they play the guitar, and sing along to it in Bisaya - I can't understand the words, but the music reminds me more of the Russian Bard genre than American Rock.  And then somewhere under the shadow of a wall, a man will sit and play the yakulili - a filipino version of the balalaika.  I see it in the family structure - the typical filipina mother working 14 hours a day and taking care of her children, while the man rests all day on the bamboo bed, and drinks at night with his buddies.  I see it in the street dogs, and street children (besprizorniki) - the latter reminding me very much of Kortik, Beleyet Parus Odinokiy, and other books describing such kids in the early soviet era.  Even politically, there are many reminders of the USSR - Like the Soviet style public service announcements appealing to people's conscience and sense of duty in a paternalistic manner (i nearly fell off my chair when i heard a message on the radio urging Cebuanos not to cheat foreigners... other messages include picking up trash and keeping the city clean.)

Another similarity with the USSR that I've discovered here is a bit strange.  In so many ways, the status of, attitude towards, and even identity of Filipino Muslims here reminds me of my experience and perception of being Jewish in Russia.  Like Russian Jews, the more traditional muslims here are found in an area that is remote to the commercial and political centers of the Philippines.  the ones who are in the city are often muslim the way I am jewish - through culture and tradition more so than through religion.  Many fully integrated into mainstream filipino society - they worship jesus at mass and eat pork and some even drink.  However, their last names differ sharply from the spanish/catholic roots, which will beg the question, "are you from Mindanao?"  "are you muslim?". 

One major difference between the way Filipinos treat muslims and Russians treat jews, is that I haven't (yet) seen overt teasing and open provocation of Muslims here.  Maybe I haven't yet seen it, but there doesn't appear to be a filipino equivalent of "bey zhidov!" and I am not even sure there is a strong negative "zhid"-like term for a muslim here.  But more "civilized" anti-muslimism here is just as prominent as anti-semitism in Russia.  It's common to hear people say that they won't do business with muslims, and often the disdain is implied rather than overtly stated.  On a larger level, they are simply ignored by mainstream society and in spite of their somewhat sizeable population here in cebu, you won't see New York style signs over shops advertising halal food, although some businesses here are certified as halal. In short, the difference between Moishe in Russia and Hussein in Cebu doesnt seem that big to me. 

But to call cebuano society intolerant would be completely wrong.  While religious minorities are privately judged, and publicly ignored the sexual minorities here are totally accepted and integrated.  I cant shut up about this topic for a reason:  it seems so unfair to me why millions of gay american teenagers must grow up ostracized and suicidal.  The maladjustment of so many gays in the US is the fault of society, not a symptom of their "gayness" - and this is illustrated so well here in the filippines.  I mean, my heart cries for my friend Maria in NY, when i see the 17 year old butch girl down the block openly, affectionately (but not explicitely for show, as in the US) walking hand in hand with her 16 year old girlfriend and first love. There is no pressure here to overcompensate - there is nothing to compensate for.  A person makes a choice on the basis of attraction, and same rules of romance, public decency, etc apply to them regardless of the gender of their mate.  Of course the "gay culture" here is also sometimes full of colorful exhaggeration in clothing and mannerisms - but these feel... more natural here i guess? 

Speaking of gays, i discovered another interesting thing here.  I realized that much of my discomfort around gay men in the states was more due to their stigmatisation, than my actual fear of being a source of attraction for them.  With the stigma removed, I feel absolutely comfortable working side by side with my flamboyantly gay groupmate, and interacting with my equally flaming physiology professor.  In fact, the level of comfort here with sexual diversity is so great that straight people will often make gay jokes in front of gays, and its never taken as insulting or demeaning, and every time this happened, I've seen gays actively join and add to the humor. 

Oh wait... I should probably mention our school acquaintance party since we are on this topic.  i thought for a long time how to describe to my american friends an official school acquaintance party with a program, the highlight of which included dressing up straight guys in drag and having them compete in a beauty pageant...  YEAH.  The top prize was called a "Ms. Gaga award", but runner ups included colorful ribbons with messages such as, "best breasts".  For me, however, the best part was watching my gay classmates observing the pageant.  They seemed to take enormous pleasure in watching the contest.  This wasn't making fun, but rather flattery through imitation.  And the open smile of my gay groupmate (and his occasional screams of surprise) are testimony to it.  If I were gay, I would NEVER go back to the US from here.

Enough demagoguery.  Next time, i'll try to post some pictures here.
02 July 2007 @ 08:07 pm

The lecture on doing health care research has been enlightening.  Although the research methodology was a Cliffs Notes version of the education I got in my undergraduate Stats and Psych courses, the insight into the Filipino healthcare system (or, rather, my instructor's perception of the Filipino health care system) has been enlightening.  Here are some notes I took in class:

1)  When there are two patients and only one available bed in the ICU, one of the patients is transferred also to an ICU.  The ICU, or the Intern Care Unit, is a bed in the main ward where an intern comes to check up on you often.

2)  When a 17 year old female and a 55 year old smoking male are both admitted in the emergency room with chest pain, the 55 year old smoking male should be given priority because, "statistically, more men over 50 suffer from cardiac infaction than women of the same age group."  (!!!!!!!!!!!!!!!!!!!)

3)  When patients are administered medication through the NG tube, the empty medication capsules are saved, and filled with sugar.  Then, these capsules are used as sleeping medication for patients who cannot fall asleep.

4)  APACHE scale (survival prognosis made upon admission to the ER) can be used to predict whether or not the patient is likely to pay the doctor.

5)  If a patient dies in a Government hospital, "it is God's will."

6)  On factors that influence doctors' decisions:  "If Drug Company A sends you to Bali, and Drug Company B gives you a ball pen, you spend the next 2 months using the ball pen of Company B to write prescriptions for Drug A." 

26 June 2007 @ 10:37 pm
Cebu amazes me.  It keeps surprising me.  At first, it seemed so homogenous, with everyone really looking the same, acting the same, etc... then I began to see the components of what made people act a certain way:  the chinese, the pinoy, the spaniard, the american in every cebuano began to come out.  And thats when confusion sets in.  Seems that nearly everything that cebuanos have inherited from their parent cultures, they've twisted and made their own.  Examples:

1)  American military jeeps painted in psychadelic colors used as public transportation
2)  Tempura here is not breaded meat, but a concoction very much like Gefilte fish deep fried in oil and served on a wooden stick shish kebab style.
3)  ATM stands for Automatic Tubig Machine -- a refill station for purified water
4)  Words are not derived from Spanish, but rather from their actual use by the Spaniards.  Examples:  Siguro means "maybe" -- a possible testament to broken promises of the colonialists.  Chica means "talking a lot" or "chattering".  Same with other language borrowings:  Mahal, which means love in tagalog, means Expensive in cebuano.  Self explanatory, eh?
5)  The American legalistic culture has been copied so well, and twisted in a filipino fashion.  For examples, everyone here loves writing and asking for receipts.  A filipina friend even takes them and keeps them for reference.  Now here's the funny part:  most stores here dont accept any kind of exchanges or returns, lawsuits here are very rare and generally cost more than the money that you win, and basically it's all trust based anyway.  My explanation?  I think business transactions here are viewed as personal relationships, and the receipt is a reminder of that relationship - the way a birthday card is, or a saved phone message. 

Anyway, i could be all wrong... just stuff i've observed.
25 June 2007 @ 03:54 pm
Just had my first exam today.  I got lucky - I passed.  Barely, but nearly half the class didn't.  Which makes me hopeful - as I learn the system here, I should continue to improve - and being in the solid middle is not a bad place to be. 

At the same time, the last 10 days I've studied more than I've had in my life.  More than for the MCATs.  More than during finals week for Orgo or Bio.  When I was admitted, the Dean informed me that we are expected to study 16 hours a day - 8 hours in school, and 8 hours at home.  I nodded my head as a sign of respect, but in my mind, i was dividing the stated requirement in half in order to get the "realistic" study time.  Turns out, the Dean was right on the money.  16 hours a day is EXACTLY how much accomplishing a daily objective takes.  More for some, less for others, but for me, it's about that much.  Of course, being me, I can't do 16 a day.  12 is what I've been able to muster so far.  So the 20 hours that I lack in the week, are for the weekend.  No way out of it.

I try not to jump to conclusions too fast, but so far, I am really happy my choice of school.  Firstly, the program here is really strong.  I don't know how the expectations here compare to US school expectations, but it seems that the depth of material is beyond what is minimally necessary.  The testing system here is quite a challenge - it contains the usual conceptual - inference type questions we are used to in the US, but unlike US exams, it is considered fair game to ask the name of some protein that was only mentioned once during an example which illustrated some important issue.  In other words - aside from understanding the material, there is an added material of being able to recognize all information, even that which is unrelated to the current topic of discussion.  I admit, I hate it.  But I also realize that through this, I am forced to memorize enzymes, structures, and concepts which will become important in the future topics that we study.  Hopefully the advance exposure will pay off.

The best thing about CIM is that they truly make the "PBL" system work.  So far, SGDs (student guided discussions, or groupwork) has been invaluable to me in giving me the framework within which to do my individual reading.  Seriously - it really helps to reach a consensus on what is and isnt important.  Also, the professor is always present during these small discussions - so if we reach the wrong conclusions, or if we begin discussing irrelevant issues we always get corrected.  Basically this format feels like semi-individual tutoring.  It actually is - there are 11 students in our group, and we get our own professor.  11 to 1 student/prof ratio really makes a difference.

Of course there are things I can criticize.  For instance, to me, SGD is completely meaningless on days when nobody has read the next chapter in the books (i.e. the day of exam).  They should really use exam days for individual study, or correlate (auditorium lecture), or labwork.  Talking about what you haven't even looked at and compiling learning issues on that basis feels counterproductive to me.

Finally, one of the best things about CIM (and possibly philippines as a whole?) is the sense of teamwork.  No, this isn't just a "sense".  Its real.  I mean, within the first few weeks, students come together and share some hard to get resources (photocopies of old exams and better explanations of material from other books get passed around), or communally strive to help review for the unit exam (cant give details but seriously... it would NOT fly in any US school... as it requires each individual student to do their small part!).  The sense of group cohesion and unity is actually a little disturbing to the average jaded New Yorker.  But... its amazing.  Maybe that's what our parents (by our, I mean us -- children of parents who came from the USSR) also experienced...

Is this hard?  you bet!  Am I sure I'll pass?  Not at all.  But if i do, I feel like Im actually getting the knowledge that I am paying to get.
16 June 2007 @ 08:37 pm
14 June 2007 @ 06:36 pm

You know how you are about to have a painful procedure, and the doctor tells you, "Don't worry, just relax", and at that very moment your shoulders tense and you feel like going to the bathroom with fear?  Less dramatically so, but such is the first week at CIM.  Amid rumors of intense courseload, and a no-life lifestyle, the first week is spent in teambuilding exercises, general school overview, and lectures on being a good to get along with person.

Ok, cynicism aside, that is probably a very wise strategy.  PBL curriculum is based on teamwork, and I feel more comfortable that there has been, at least in theory, a presented standard on how teams should operate.  Besides, it's hella fun.  I mean, attempting to put 8 people onto a 1.5 square foot spot on the floor is an experience everyone should have at least once in their life.  Tricky physics questions (which way does the water in the toilet spin when you flush?  Bro, do you have an explanation for this??) also helped our brains to come out of their dormant states...

We've also been assigned into groups.  My group seems a bit different from all others - we have a disproportionate number of "foreigners" - aside from myself there is Cherry who lived a while in NJ (but went to college in Phils), a filipina from Vancouver named Hester, a girl who lived a while in hawaii and japan named V, and of course there is me.  Aside from us, there is a shy girl named Nina, a shy boy named Julius (who appears to be very popular with the girls in spite of short stature and shy ways), a kid named Nino who appears to be one of those good boy achievers parents are always proud of, Ron the jokester, Patty who is very sweet and likeable, and Joan whom I havent had a conversation with yet.  All in all, 10 people in the group... but it doesnt feel large.  In fact, I hope that my initial good impression of my team only lasts... as I looked around the room at other teams, I felt glad i ended up in this one. 

So this is the lull before the storm.  I will use this week to get as far ahead in my reading as I can.  About 1/3 of my classmates already have a nursing degree, and another third a degree in medical technology.  The rest are bio majors, with the exception of another psych and one engineer.  So... i am behind already.  Maybe this week I can even the starting field a little.  Just a little.

12 June 2007 @ 04:21 pm

There was no escape from it.  I was about to commit an act against which every Jewish chromosome in my body cried with the tears of a thousand rabbis.  An action that stands against logic, reason, common sense of every neuron in my Atheist brain.  "The mass is part of school activities, and therefore, attendance is mandatory," i was told in the administrative office.

So here I was, like the character of Brandon Frasure (sp?) in School Ties, standing alone among an army of Catholics who were singing praises to Jesus, and crossing themselves.  Like the Marranos of 15th century Spain, I was a willing, yet coerced participant of the same rites, which from the days of Inquisition to the days of the Holocaust, my ancestors gave their lives rather than accept.

This very first hour of the day, nearly overshadowed the thrill of commencement of medical school.  In hindsight, I don't know how to feel about it.  Or rather, I don't know how bad I should really feel.  I mean, when I had a rectal exam at the GI doctor's, I also was a willing participant in an experience which under any other circumstance I would not submit to.  Was this, also, a type of rectal exam?  One that would lead to a better future for myself and my family?  A small price to pay for a greater good?

There is also the question of how much was really expected of me here.  I stood when others stood, and I sat when others sat - that's exercise.  During the sermon, in order to seek some mental refuge from the onslaught of jesus-babble brainwash, I recited the first chapter of Snell's Clinical Anatomy that I reviewed the night before.  This is a rough transcript of my mind during the sermon: "Blessed be the Lord, our Christ.....  The skeletal muscles connect with Bones, Cartillage, or Ligaments....  And so, the little boy was now her favorite student, and he told the teacher, you are my only family now as my father passed away last year...  Tendon, aponeurosis, and raphe are the three types of deep fascia connecting the muscles...  AMEN!" So all in all, its not like I renounced my mother during this whole experience.

Am I prejudiced?  I ask that question too.  Many in my position would not ask this - after all, I didn't volunteer to go to the Mass - I was obligated to do so.  And yet, in all intellectual honesty, I must ask myself this question.  For instance, later on, when everyone stood and sang the Philippine national anthem, I didn't feel bad at all, standing alongside them.  Although I have no allegiance whatsoever to this country, and would never pledge it of my own free will - I didn't feel emotionally disturbed as I did during the psalm singing during the Mass.  Maybe it's because loyalty is something i can at least relate to, while being surrounded by a crowd pledging love for an imaginary friend made me feel like a patient in an insane asylum.  Or maybe it's because Filipinos never killed any of my people, and were, too victimized by the same opressors in whose footsteps they now actively follow, whose actions and religion they now emulate.  Either way, because my participation was limited to attendance and sitting down/standing up on cue, I can't really say that my foreskin is now growing back (by the way, Filipinos are strong believers in circumcision).  Regardless, it was still a very unpleasant experience.

P.S. To be fair to the Philippines, what happened to me doesnt appear to be representative of the Cebu as a whole. OOverall, people here are extremely tolerant and openminded.  The same supermarkets that do prayer at 6PM daily play shopping music that includes such 90s hits as, "You've got to lick it before you stick it", and "Can you feel the jam that's pumping while you taste a piece of mine?"  Even at CIM, after lunch break, Dr. M. gave a quick prayer before an orientation session, then afterward, told the students that those who do not wish to pray may remain seated in the future (man... thats all I ask... just a little respect for my beliefs... nothing more!).  She was also the one who volunteered an alternative to the female dress code that was passed out, which also satisfied the requirements of the Islamic faith.  Maybe she is only a progressive individual... or maybe it was the administrator which told me to attend mass who was still in a colonial frame of mind...  I guess I will find out.

P.P.S.  Today is Independence day of the Philippines.  As it is written on the Filippine Piso bills, "The Filipino is worth dying for."  I didn't die today, after all.

11 June 2007 @ 05:45 pm

1)  Third world politics:  Mr. Osmena, governer of Cebu won his reelection.  He won it in all barangays (provinces) except one, Lahug, whose captain is Ms. delos Santos??  I  forgot her name... but anyway, during the election Ms. Delos Santos stated in a political letter that Mr. Osmena has never done anything for Lahug.  After winning, Mr. Osmena immediately suspends construction of a new school until Ms. delos Santos issues an apology for her statement.  (ego stalemate follows).
2)  More third world politics:  There is a recent push to dismantle (euphemism for demolish) illegal shanties built on undeveloped land.  Basically, when poor filipinos come from provinces they settle in makeshift houses until they either move up to the city economy or rot in the worst poverty and filth a person could ever imagine.   The image of a dirty, naked, 2 year old girl sitting in the middle of a busy sidewalk has been lingering in my mind since i saw it 4 days ago in Lahug.  Anyway, the Philippine government is selling off these lands to private corporations for development and resale to foreign investors.  So in Manila as well as Cebu, these shanties are being torn down by excavators and pulis in riot gear.  SunStar sites the reduction in crime around these areas as one of the justifications for doing this. 
3)  There are numerous half-dug ditches, half-demolished buildings, and blocked off torn-up roads in Cebu, all with a giant poster featuring the filipino president's face with the words GMA (the acronym of her full name) CARES - reconstruction project.
4)  Unlike much of the third world, there appears to be a great degree of freedom of speech here.  Although i personally avoid political discussions (except here), I hear people around me freely calling their president "Joker Arroyo".  I dont know about the rest of the Philippines, but Cebuanos seem to love hating Pres. Arroyo almost as much as we New Yorkers love to hate Bush.
5)  I am hereby making a prediction, and only time could prove me wrong.  Cebuano, the most widely spoke language in the Philippines, will be extinct in two generations.  Why do I say it so freely and confidently?  Because there are NO scholastic dictionaries of the language available at any of Cebu's bookstores (there are non-scholastic missionary compilations, some of which are actually crap because they contain words from other filipino languages mixed in with Cebuano vocabulary).  Because no bookstore I've visited has any CHILDRENS books in Visaya (another name for Cebuano), nor are there any serious literary works - only cheap paperback romance novels with inventive titles like "the great love".  I have yet to find ONE university that teaches a course on learning or speaking or reading cebuano...  And there are no grammar guides to cebuano at all.  Can anyone say Yiddish???  Because that's the way this language is going.  I have no idea how I will learn it in time for patient interviews....

10 June 2007 @ 08:13 pm
1)  All books about the Philippines, especially those about Filipinos are crap.  They may describe your upper-middle class Manila culture, but they are absolutely irrelevant here in Cebu.  I stopped opening my "culture shock" series book because nearly everything there is wrong.
2)  One thing books about philippines claim is that pointing with a finger here is rude.  Well, in Cebu, pointing with a finger isnt rude, but it just means something slightly different.  By pointing in a direction with a finger, you are also saying that the thing is nearby.  To point in the direction of a faraway object, lips are used (the way B****i. likes to point).
3)  Making kissing sounds means "look here".  Men do it to other men.  I guess kissing noises ARE the way to get attention.
4)  I was cracking up when I passed by a bar that had a big sign in front, "GAY BAR".  I love the directness of it.
5)  Speaking of gays, here in Cebu a woman who sleeps with other women is not considered a lesbian.  In fact, there is no special term for such a girl - its considered completely within the norm.  The term lesbian is strictly reserved for "butches", women who dress and act like men.  These are not looked down upon, but when referred to in the context of a relationship with a woman, they are called "boyfriend".
6)  Cebuanos hate walking.  Everyone has been looking at me wide-eyed because I take neither taxi nor jeepney to go to the mall, which is about 10 minutes away walking.
7)  When you buy a movie ticket, you get seats assigned to you the way you would in a theater - with different prices for "orchestra level and the upper level".  Bringing outside food is completely allowed, but not drinks. 
8)  Filipino men are alcoholics.  Every morning during breakfast I observe the parade of men on my street with fresh, cold 40-oz bottles of Red Horse (8% beer).
9)  I was passing by Ate Joy's house on Sunday morning, when I saw here sitting outside, picking her daughters hair.  Memories of Russia overwhelmed me, and I began missing my microscope which at 6 years of age I used to view my own lice.  Ate Joy was angry at her friend who came to visit her from Cagayan de Oro with her kids.  "Those CDO kids always come here with lice and infect mine!" fumed Ate Joy.  As I sat there chatting with her, she began telling me a Cebuano folk tale (for the benefit of Saina, her daughter, who was sobbing when she mentioned the possibility of cutting her hair "short like Cui Sam").  
There was once a beautiful woman with gorgeous long hair.  Every day when she came out of her house, men would wait for her and attempt to run after her and grab her hair.  But she was so full of herself, she really took it all for granted.  She also didn't know what lice were.  So when one day she came out of her house, and men saw huge lice hanging off her long beautiful hair, they began running after her screaming "Koto-koto-koto" (meaning louse louse louse).  But she thought they just wanted her for her beauty and kept walking.  Hence she became the koto girl.  (Cui Efram continues the story) Then one of the men fell into a manhole.  He couldn't talk but he had to ask for help, so he reached up with his hands above the manhole and made this gesture (Cui Efram shows how a louse egg is popped with fingers) hoping the koto girl would notice him, but she didnt. (at this point Saina stops crying).
10)  Talking about poop here is considered a perfect way to make a joke. From Cui Efran telling me, after installing the shower, "now you can shower and poo at the same time", to the nurses who were laughing openly and in my face when i came out with my stool sample for the Quarantine Clearance, I realized that here it's ... well, less taboo for sure.
10 June 2007 @ 02:02 pm

A week has passed, and I've finished settling in.  Ate* Joy (the landlady of the lodging house where I stayed during my interviews) has been helpful beyond expectations.  On the very first day of my arrival, she and her husband took me shopping to their version of Costco, and loaded up their 1979 freshly painted lime green with tinted windows toyota car with all the necessities that I bought.  She helped me pick out curtains and curtain rods, while Cui Efran (her husband, a tall dark police officer with a kind face and somewhat cynical humor) installed them for me.  

My room is shaped like this:
| bathroom|
|          |
|          |___

And before moving in, I also wanted extra shelves over the desk, as well as a screen front door for the mosquitoes. Ate Edna, my new landlady, gladly agreed to find me a carpenter.  I gave her 3000 Pesos, ($65) for parts and most of the labor.  However, two days later she told me the parts were 2800 pesos, and I need to pay 2500 more for the pacquiao (work).  Ate Joy was furious when she heard it.  As a real estate broker, she said that there is no way the parts were worth that much, and that the work was worth 800 pesos at the most.  She came with me and yelled at the carpenter and brought him down to 2000.  I told Ate Joy it was my mistake trusting Ate Edna to arrange on my behalf and I should have suspected she might alli herself with the carpenter to make some money.  I told her I consider the matter closed, but as it turned out, Ate Joy went to Ate Edna the next day, and told her that she was there not on my behalf but on her own, to tell her she should be ashamed of herself for lying to me - and that if she decided to take my money, she should just admit that she took money for her "services" on the receipt.  That is how I got the receipt for the parts (the real receipts were conveniently "lost") that included 1000P charge for "Edna's services and Cleaning".  As it turned out, I was the one doing the cleaning.  I just wanted to keep the peace...

You all may think this is funny that so much commotion is happening over a few dollars.  Philippines is poor, but not that poor.  Amounts like 5000 ($100) are not insane amounts of cash, unless you are a squatter from the provinces.  I suppose in our economy it would be equivalent to maybe $800?  Regardless, to me it was the idea that I was being screwed, and i didnt want to set a precedent for my lady where I pretend to be ignorant of what she is doing to me.  Anyway, since then, she's been acting like a gracious hostess, and hasnt engaged me much except with an occasional smile and "helo".  

So now I have my beautiful room.  No aircon, but I bought a really strong fan that I even need to turn off sometimes because I feel too cool.  My neighbors are great too.  There are 4 little girls in our yard who absolutely adore me, especially the 3 year old.  She runs up to me screaming, HI SAM I AM CHRISTINA!!! And rubs my hand.  I told her auntie (who was watching this with an amused look) that I am always popular with women under 5.  But when i am in my room, nobody bothers me, and I like that.  I bought some of the books i'll need, and im already finishing the second chapters.  I like studying here.  And Im glad im finally studying the shit that I actually will need for my career.

*In the Philippines, it is the custom to address people politely.  Strangers who are older (or even same age) are called Ma'am and Sir with the first name to follow.  So you bitches better call me Sir Sam from now on.  Now, when there is a friendship or business relationship, the proper way to address someone is Ate (literally meaning big sister) and Cui (literally meaning big brother).

04 June 2007 @ 08:34 pm
I am here.  Cebu once again welcomed me with its dirty air, its honking jeepneys, it's loud populace and its opportunities for my future...  

Getting here takes a lot more than being accepted into a school.  The following is an overview of what one must do as a non-filipino to enroll (this will get edited as I find out more... im still in the process!).  This is of no interest to anyone who is not thinking about going to medical school here... im posting this only for the benefit of crazies like me.

By the way, there is a bright side to the bureaucracy.  As I ran around completing paperwork, I got the opportunity to say goodbye to my beloved NY, its twisted downtown alleys, it's majestic skyline, and its filthy, inefficient, but heartwarming subways..  Maybe that's the whole reason for the paperwork.  To show potential students abroad what they will be missing...

A)  How to get a Visa in 10 days.

Well, you cannot get a student visa in 10 days.  But you can get everything for it!  You need:

1) A "mamas boy" certificate (certificate of good conduct) from the main branch of the police department in your city.  No need to quiery for federal, Philipino authorities only want to know you didnt commit any crimes locally.  This certificate can take 10 days to complete.  File it first.
2)  Affidavit of Support.  That simply means your bank statement showing like $20K on the account or so, or a bank statement like that from your parents with a note stating that they will support you for tuition and living expenses.
3)  Official college transcript.
4)  Note that 1, 2 and 3 need to be NOTARIZED.  For those of you who are like me, ignorant of such scary terminology, it simply means that these documents will be signed in the presence of a person who has the right to sa YES the person signing IS in fact the person signing.  Dumb ain't it?   For #1 this is done by requesting a "live signature" with your certificate of good conduct.  For #2 this is done by requesting a notary to sign it at your bank.  You will need to bring a notary form...  something standard like, "I hereby attest that the attached account statement belongs to me, YOURNAMEHERE".    This is the form the notary will sign.  By the way this doesnt PROVE that the statement is in fact YOURNAMEHERE's.  All it proves is that the SIGNATURE ON THE NOTARY FORM belongs to YOURNAMEHERE.   Kapische?  Anyway, for #3 you will need to request that your registrar's office at your school notarize the transcript.  Simply "official" transcript won't do, it MUST be notarized.
5)  So you have your shit notarized.  Now, take it to the county clerk's office.  If you live in an area with multiple counties, make sure you know which county has your notary's signature on file.  It is proper form for the notary public to include the county on the notary stamp, but SOME WILL NOT.  So check with your notaries where they have their signatures filed, and go to the COUNTY CLERKS OFFICE in each of the above counties, and AUTHENTICATE the notary stamp.  That will get you a piece of paper stapled to your document that says that your notary is real, and isn't your grandma.
6)  Check with your local Philippine Consulate whether county clerk's authentication is sufficient for them to AUTHENTICATE your document (filipino style this time).  If not, you will need to bring your documents (authenticated by the county clerk) to the Apostille office in your state.  The state Apostile is the ULTIMATE in notary recognition, and is governed by international treaties.  If you live in NYC this is unnecessary, but if your residence is elsewhere, you might have to take this step.  Note that it is possible to do apostilles by mail.
7)   You will also need your NMAT results, a certificate of graduation, a letter of acceptance from you school, a US passport, LOTS of 2x2 photographs (remove your glasses, and its cheaper to take just one or two and make photo paper copies at kinko's), and a lot of patience...

At this point you have some decisions to make.  There are two ways to get a student visa:  Simply get one at your local consulate, or enter Philippines as a tourist and apply for a visa conversion.  Getting a visa while in the US is an attractive option.  However, you should choose it only if you can say YES to all of the questions below:
1) Your school has already received, and is willing to send you the Certificate of Eligibility to study Medicine (CEM)
2) You have all of the above paperwork ready, and 2 more months before classes start
3)  You are willing to submit to medical testing (get form from the Phil consulate) and get a TRAVELLING NOTARY to notarize your doctor's signature on it.  Travelling notaries are listed in yellow pages.  I recommend Stephen Reich (look him up) if you are in Bronx, Manhattan or Queens counties.  Note that procedures #5 and #6 above will still need to be followed here - you must get the notary signature authenticated and possibly apostillated.

If you are like me and one of the 3 questions got a negative answer, your ONLY choice is to enter the Philippines and apply for a student conversion.   The following procedures apply in this case:
1)  Do not get any health forms done in the US.  They will not be accepted in Phils.
2)  Bring all your notarized/authenticated (and possibly apostillated) documents to the Phil consulate and have them "AUTHENTICATE IT WITH A RED RIBBON".  Without the red ribbon your documents will be meaningless in Phils.
3)  I suggest paying for a 59 day tourist visa while you are authenticating your documents.  For that visa you need a bank statement showing at least $2000 and an itinerary (purchased tickets).  Itinerary is a bitch because you need a departure ticket from the philippines even though you are going there to become a student.  You can comply by:
a)  Buying a super-cheap one way ticket out of the philippines using a local asian airline like cebu pacific (www.cebupacificair.com).  A ticket to Kuala Lumpur is roughly $60 with tax included.
b)  Buying a really expensive fully refundable ticket from a reputable airline.  Good news is you can cancel the ticket after you get your visa, and get your money back.  Bad news is that even within asia, refundable tickets run about $500 and who wants to risk that much cash on a flight that you don't even intend to board??
c)  Find an old electronic ticket (say, the one for your med school interview trip to Phils) and doctor it using HTML (or an HTML editor) to look like an exit ticket for a future date.  Good news is that it lets you save on unneeded expenses.  Bad news is that you GOTTA be good at HTML... if you are caught... well, i dont want to be you.
4) Upon arrival in Philippines, go to Quarantine office and obtain a certificate of health.  After that, go to Bureau of Immigration, and pay a fee.  If you are in Manila, you can pay all the fees at once.  If you are elsewhere, you'll need to wait for your certificate and fee to be shipped to Manila, sent back with a receipt, you come to B.I. again and pay fee #2,  they send out the form again, wait for it to arrive, whereupon you pay $50 plus a third fee, and you get your visa.  Make sure that your school explicitely agrees to your starting your courses and enrolling while you visa conversion is taking place.  Remember, you are a tourist until you have a student visa.  I am lucky, since CIM was willing to allow me to attend class while I apply for the visa.

All this sounds like excessive paperwork, and it is.  Most of what I wrote here must be discovered by trial and error.  THe notary authentication process, the travelling notary, choice of manner in obtaining student visa, and so on isnt the kind of info that's given to you by either the school or the consulate.  So, print it out, and try to follow the instructions.  I think they work.
12 May 2007 @ 03:06 am
How does one move across 12 time zones?  Very painfully.  It's beginning to hit me now.  I am saying goodbye to my parents.  I won't see them for at least a year, maybe longer.  At 28 years of age, I've never been away for more than two months.  Ever.  And I am scared shitless.  It's not like I need my parents every day.  If anything, i've always elected to have some distance from them - I haven't lived in their home for an extended period of time in 9 years now.  At the same time...  not seeing them for 3 weeks brings homesickness.  But a whole year?  I'm a fucken crybaby.

One thing about parents is, you never really see them aging.  Sure, I look at their pictures from 10 years ago, they both look so much younger.  The process of getting older happens so slowly, however, that without those pictures, I could never guess just how much they've aged.  And now?  Seeing them after a year or longer away might shock me...

In my first post I ranted heavily against the Carribean Med School establishment.  I still feel it is a rip off.  However, I badly underestimated the distance factor of education in the Philippines.  20 hours by airplane is no joke....  All the friends that will forget me, all the family moments I'll miss, all the things I love about my country - this is the additional cost of attendance in the Philippines.

I haven't doubted my choice.  Not for a moment.  Honestly.  However, I am looking at it more realistically now.  To me, still, 1) quality of education, 2) reasonable price, and 3) a degree that is accepted by every state in the US remain the biggest and only selection factors.  And by those factors, I believe I made the right choice (since I had no hope of getting into a US school).

Now... should I get a pet rooster when I move there?:>)  Only kidding.
15 April 2007 @ 07:47 pm
I am posting this about a month after I got back from Cebu.  The city left me with a strong, positive impression.  Sure, it has the same negative points as Manila.  I was also harassed around tourist areas.  Also, I got my cell phone snatched at a disco.  It was really funny too - I bought a cheap one just to help my family locate me.  Last time I wasnt able to call for two days, they even called my ex-girlfriend to find my whereabouts.  Yeah.  So it was funny that the very day I bought it, it was snatched.  The thief was a gay-looking man dressed in a pink shirt.  I noticed him trying to dance close to me on the floor, and moved away.  Suddenly I see him close, and feel something against my leg.  IN THAT CONTEXT I really didn't want to know what it was, so I just went to sit and have a drink.  Turned out that it wasn't anything bad, just my cell phone being pulled out of my pocket.  I think i deserved that lesson.

Now back to the positive impression part...  Aside from the touristy downtown, it's a pretty laid back town.  The smaller streets have dogs and chickens walking about, the people seem friendly and curious.  Nearly everyone wants you to know about their cousin/uncle/brother in law who is in America, and they all want to know if Texas is close to New York...  it's fun.  It's even more fun when an old man comes up to you and offers you to touch his cock.  Of course he means the rooster.  Cockfighting seems to be one of the main attractions in cebu, and every unemployed male there seems to be in the rooster raising business.  When i come back, I will definitely see a fight.  Cruel, maybe.  But not as cruel as the slow, painful death through poison and / or traps that we subject subway rats to in NY.  Rats are much closer to humans in brain development... if we can do this forcefully to an intelligent creature, I cant imagine why we cant have fun with a couple of roosters who actually WANT to fight.


Cebu Doctors University was underwhelming.  Maybe it was the ease with which they offered to accept me.  Maybe it was the students outside...  I know it's not a valid statistical sample, but it was the only school where nobody was excited about attending there.  Students on the street weren't particularly friendly at all.  And their PBL system wasn't something that impressed me.  They actually do trigger questions with first year students.  Come on!  Why waste time on conjectures??  Teach us something first, THEN ask us.  I thought it was a bit silly.

Cebu Institute of Medicine was my favorite of all the Philippines schools that I visited.  Not only was their price fair, their students and administrators seemed to be crazy about just one thing: learning/teaching medicine.  Everyone I spoke with told me it was a tough school.  Nobody regretted attending there.  They all felt excited about their future careers.  One kid insisted that I write down a textbook that "will definitely explain everything to you."  In short:  it felt like a truly academic place.  And besides, I like living around CIM better than the area around CDU. 


So, there we have it.  I've made my choice.  And unless CIM backpedals on their offer, I'll be going to cebu in 6 short weeks...   I cant wait to start learning medicine!  I cant wait to discover how valid (or wrong) my assessments and decisions were.  I can't wait to learn Bisaya and communicate with my 3d and 4th year patients.  I cant wait....
11 March 2007 @ 06:34 am
I never knew Magellan, but I feel for the guy.  After only 24 hours on the airplane, I was dying of exhaustion - and yet I was a far cry from the year and a half by boat that it took Ferdinand Magella to reach his Philippine destination.  Yet, like my conquistador friend, I stepped on the shores of this place completely unaware of what it would be like.  After being hawked at the airport by taxicab drivers (desperate for riders, and exhasperated by their "non-working" meters), I climbed into a jeepney with my bag.  That didn't go too well - I didnt know the area, and I somehow ended up on the side of Airport Road not far from the Airport - hardly a place to be, when you are looking for a hotel.  I relented, and grabbed a taxi.  Apparently, all the meters "start working" outside the airport, and I got to my destination for under $5.


It would be hard to describe Manila with a single sentence.  It is both a gem and a garbage can.  The site of wealth and unbelievable poverty.  My first impressions were a mix of positive and negative emotions.  As a caucasian, you get heckled a lot around tourist areas.  Dirty kids, with outstretched hands, who will follow you and grab onto you in hopes that you would pay them off with a peso or two.  Their parents, often keeping a sharp eye on them from the background, have taught these child beggars to be loud and relentless, in order to maximize the loss of face incurred by their "donor" should he fail to pay up for their efforts.  I don't know if some of these kids are really hungry.  I don't know if the parents' role in this game is a matter of survival, or child exploitation.  But I refuse to give money to kids.  I can't bring myself to support this "school of begging" that will no doubt leave a huge psychological impact on a growing mind.  Call me callous, as I had never gone hungry before.  But my choice is to ignore the beggars, in spite of the sometimes embarrassing way in which they follow, harrass, and demand money from me.

There is other type of heckling around tourist areas as well.  In downtown Manila, I was quite often followed by shady characters trying to sell me fake watches, Viagra, as well as prostitutes.  At first it was shocking, but then it became something I've learned to tune out like the sirens of ambulances, or the preaching through the loudspeakers of churches.  In the end, I couldn't say to anyone, "Ignore downtown Manila."  Because it is gorgeous!  The gorgeous cathedrals, the old Spanish streets of Intramuros, the beautiful Luneta (Rizal) Park and its museums, free concerts, and exhibits...  I also loved the Baywalk, and its many little cafes, outdoor bars and restaurants, and free live concerts..  Although the Baywalk is the epicenter of hustle, it is also the coolest.


Because I was interviewing at University of the East Ramon Magsaysay Memorial Medical Center (UERM for short), the registrar at UE arranged for me a condo apartment that I could rent for as little as $11.50 per day.  The building, located at the border of Quezon City and the barangay of San Juan, was an impressive 5-floor walk up.  My room number was 411.

That area gave me a totally different impression of Manila.  There were no tourists there, in fact, I only saw one caucasian in the area the entire time.  Located near several other schools, the area is teeming with young people wearing uniforms of their school, or the whites of a health profession.  Yet a small step outside the congregation of sidewalk eateries, internet cafes and copy centers, as well as the gates of the campuses leads into tiny, narrow, winding streets with shanties crowding on both sides.  Just one step - and the honking of the jeepneys is replaced by the cries of roosters and the barking of dogs.  Clothes, drying on ropes stretched above; sari-sari stores, or little windows of private houses selling soda drinks and batteries; kids playing in the streets...  this is where it hit me just how far from my city I really flew.  

This is also where I discovered the proud Filipino.  Far from the degrading behavior of hecklers downtown (can't judge them, as they are likely collecting money also for their families), the people of shanties live a dignified and poor life.  The friendliness was overwhelming.  Every place I stopped for a snack, or a bottle of water, the host would engage me in conversation.  I think it was a combination of curiousity, with hospitality.  They tried hard to not make me feel like a foreigner, or alone.  I'm no expert on Filipino culture, but it appeared to me that it's unthinkable in their mind-frame, for someone to eat alone and not be lonely.  


This part will only be of interest to potential med students in the Philippines.  UERM left a very positive impression on me as a school.  The administration was the friendliest - they were eager to answer questions, and ready to be transparent about facts. Every thorny question was answered candidly, often by presenting concrete evidence.  For example, to my question, "What is your attrition rate," the registrar immediately pulled out the print-out of a spreadsheet, listing the students who didn't make it last year, the reasons why they dropped out, and their percentage counts in relation to their class.  

The school also demonstrates responsibility toward their students.  For example, when their total PBL curriculum began to show deficiencies, they offered free summer review sessions to all juniors and seniors who were on that track.  They also switched some parts of their curriculum back to traditional, which has made their students rank highly in the past.

I spoke with a few students there, and they seemed to be happy with everything about UE, except for that PBL curriculum that has now been phased out.  The campus itself appears clean, and classrooms are airconditioned.  The labs and the hospital appear well equipped - however, there is no MRI machine.  

Best feature of UERM is their direct affiliation with US hospitals in New York and Chicago.  For about an additional $7000, one can spend 10 months of the 4th year doing clerkships in those hospitals.  While many Filipino schools offer such an option, UE is rare in that it's affiliation is direct, and there is no need for students to search for a US hospital to "take them in" for some given rotations.

Overall, UERM left me with a highly positive impression.  My only major criticism is that, like all Manila schools, they charge a $10,000 "development fee" for all foreign students.  It's non-refundable, and due on enrollment.  However, including the foreigner fee, the tuition, as well as $7000 in US hospital fees for a 10 month rotation in the USA, the total cost of tuition is still under $30,000.  FOR THE ENTIRE 4 YEARS.  Not per year!  Take THAT, UAG Tecos!!


The one thing that appeals to me when it comes to education in the Philippines, is their emphasis on theory.  While in the US, third year in Med school is spent exclusively "in the field", third year medical education in PI is still classroom based, with some hospital exposure.  In my opinion, this is superior.  In residency and subsequent practice, a physician will have no shortage of clinical cases.  Spending extra time on the books is not a luxury many exhausted residents and doctors, who often have children already, could afford.  I would rather lack in clinical skill initially, if the pay-off is a stronger theoretical base upon which to base my diagnoses and treatments.  

Don't get me wrong, if I had a chance to attend school in the US, I would.  Nothing trumps staying at home, and being evaluated based upon just merits, without the I-M-G stigma staining all post-graduate achievements.  However, as a future IMG, I like the Filipino model of education best.
21 February 2007 @ 10:54 pm

I felt the eyes upon me.  As I waited in the crowded, narrow hallway at the Philippine Consulate of Los Angeles, I became acutely aware of my pale white skin, shining conspicuously among the many shades of yellow, orange, and light brown.  However, something told me I was in the right place.  Many of the younger fil-ams in the crowd had their parents with them.  They were all nervous - this gave me a sign that, perhaps, this was something worth striving toward.

Medical school in the Philippines.  To me, the sound of this always smacked of recklessness.  I was taught well by my college advisors: if you can't get into a US school, take more courses.  If in a rush, go to the Carribbean.  Carribean.  The big bad quadro: St. Georges, Ross, AUC, and the up-and-coming Saba medical schools.  And Universidad Autonoma de Guadalajara, the "fifth pathway" alternative.  For such a long time, I bought into the lie that these schools were somehow, "not quite as foreign" as other offshore options.  Whether their credibility has been inflated by an enormous advertising budget, or whether they hold a geographic proximity trump card for most US med students - it took me a while to realize that all these myths were just not true.  Especially when it comes to the Carribean schools.  Like it or not, you ARE an IMG if you attend these schools. I-M-G: functionally defined as a step below the lowest ranked student of the least reputable medical school in the US.  


It wasn't meant to be easy for me.  Like many other non-traditional students / post-baccs in pre-medicine, I fell off the "legitimacy" boat to medical education.  For every reason there are tons of excuses.  For every excuse there are 1/tons of legitimate reasons.  In the end, like most late 20-somethings in my position, I had to make a choice:  spend 2 or 3 years obtaining a masters' degree in order to distance myself from my shameful undergraduate record, or risk having the scarlet letters IMG sown onto every diploma and professional certificate that I might earn in the not-so-distant future.

I made the latter choice.  At my old age I want to learn things that are directly relevant to my career of choice.  Surely, taking many bio courses prepares you for med school.  But just as there is overlap, there is also an unforgivable, quite forgettable amount of information that will hardly make me a better physician.  I've had enough of this in pre-med.  Recognition of the phloem in the microscope and recalling from memory Grignard reagents could neither make me a better diagnostician, nor would give me the knowledge to prescribe more appropriate medications.  

Having decided when to apply to MD programs (NOW!) the question became where and how.  In spite of having been spoonfed the myths about the "Harvard of the Carribbean" i.e. USG, I had found many flaws in this school, and those like it.  I do not question their ability to give me an MD degree recognized by all 50 US states, nor do I question the fact that they probably bought their superior reputation not only with students, but also with residency admissions committees.  However, as institutions of learning, I found them to possess the following flaws:

* lack of transparency that stems from lack of accountability.  These schools aren't in any way tied to either their community nor their host country. The Dutch could give a rats ass what AUC teaches, and how it teaches.   While medical boards from individual states, most notably California might visit and assess such a school for its credibility - these inspections are neither frequent, nor unannounced.  In either case, it's a far cry from the rigorous state regulation and requirements imposed upon medical schools in most countries that actually serve a large segment of their population.
*  focus on the bottom line.  How does one run a medical school as a business?  Charge exhorbitant tuition, hire fewer instructors, and insource the ones you do hire from English speaking poorer countries.  With tuition rates above most US schools, disguisting student-teacher ratios, and shortage of US instructors, these schools look more and more like Indian/south african/filipino schools with an inflated tuition. 
*  teaching to the test.  Its not teaching, it's cramming.  My only question is just how much of the "superior" USMLE passing rates are due to mandatory Kaplan review at these schools, something that US-based students might choose to forego.
*  Many of these schools are the biggest economic factor on their Gilligan's island.  Whether this is due to fact, or unfounded paranoia, you find much talk on the boards about practices by these schools that have a Soviet stink to them. Whether its limiting student food choices by fighting against food merchants that aren't a part of the school cafeteria, or scowering the internet for personal blogs of students and threatening them into withdrawing negative information, or insituting the rule of not mentioning professors by name on medical boards - these practices are undemocratic at best, and coercive at worst.  
*  All of this comes at an enormous price tag. My modest estimates put the average cost of attending a Carribean school or UAG at over 200,000, if it is to include living expenses.  Remember, these schools jack up the cost of living too.  While the island of Dominica is undeveloped for the tourist industry, you'd think otherwise if you were to look at the cost of living in the vicinity of Ross.  Compare this to a budget of $50,000 which would easily allow any US student to complete his education in the Philippines, while living like a king.  I believe that budget would include occasional house help, and some 4th year clerkship rotations in the US.

Before I get flamed, let me be clear:  I tip my hat to ALL Carribean IMGs who in spite of all the obstacles above, managed to get their degree, to establish themselves as practicing physicians in the US, and with their own success have boosted the reputation of their Alma Mater.  But I separate the people from the institution.  And the institution has, to me, some flaws that are incompatible with my personal goals.


The doors of the big auditorium at the Philippine Consulate opened, and students were called in by name.  When we all sat down it was official: I was the only one in the room without a drop of Filipino blood in me.  Not that it mattered much to me, but it made me doubt just how wise a choice I was making.  Perhaps it was an exclusive club: a fil-am network of compadrazco in getting new graduates placed in US residency, of which as a non-filipino, I'd have no part.  Perhaps it really is... but sitting here now, it doesn't appear to me that way.

Toward the end of the exam, I fell asleep. The NMAT, or the National Medical Admissions Test, the Filipino counterpart of the MCAT was a grueling experience.  Along with traditional Physics, Chemistry, and Bio questions, there are many which come from the left field completely.  IQ style picture detail questions, and inquiries into social theory were beyond my expertise.  But somehow, I aced the exam.  It became clear:  in spite of my horrific undergraduate record, I would have the opportunity to attend medical school... in the Philippines.