COMMENCEMENT ADDRESS: To stand alongside our patients in our struggle towards what ensures Health For All: Social Justice

Dr. Omid Siahmard during the UPCM Class 2021 commencement exercises. Screengrab from the UPCM 2021 Youtube Page

(Delivered by Dr. Omid Siahmard of M’lang North Cotabato, as representative of Class 2021 of the University of the Philippines’ College of Medicine, during their graduation on 8 August 2021.)

In the rare breaks wherein I can finally savor the luxury of eating, I would usually buy squid balls in sweet and spicy sauce or egg sandwiches with cheese.

One afternoon, after assisting an operation, I bought six squid balls at five pesos each from a street vendor right across our hospital’s outpatient department. As I waited for Kuya to prepare my meal, together with grocery store employees who share my affinity for street food, a police mobile suddenly pulled over.

A clearing operation was likely scheduled that day, as an ordinance allowed authorities to clear sidewalks from vendors and beggars as if they were merely an obstruction along the busy streets of Manila. Kuya did not move a muscle, and his wife looked uneasy. Luckily, without any word from the police, they restarted the mobile within minutes, slowly drove by a mall owned by a multi-millionaire, and left.

“Next time Pa, malayo pa lang sila, takbo na tayo,” his wife uttered in fear, knowing that being apprehended by police that day would have cost them their meals and monthly rent.

On Fridays, I would usually buy an egg sandwich from a vendor stationed in front of the building where I live. A sandwich is worth 15 pesos, and an additional five pesos would give you two extra slices of cheese. Vendors in that area knew that I was a UP-PGH medical student, and they would ask me about their health concerns such as long-standing joint pains or a non-healing wound. I would inform them of the probable causes based on the information they offered. And I would advise some methods and over the counter medication for symptomatic relief.  I would also tell them to seek  consultation from our OPD and to have laboratory and imaging tests done so we can properly diagnose and treat them. But the usual response was that they could not leave their stalls even if they wanted to, due to the threat of their stalls being cleared by the city police. Often I could only nod in agreement, as I told them that I understood their concerns. As soon as I took the last bite of my sandwich, I would leave and go back to the classrooms where I learned how to treat illnesses, inside the halls of the university where I was taught that more than dealing with symptoms, we have to identify and treat the disease itself.

I kept this routine for five years. In those five years, stone walls separated me from Kuya street vendor and his worried wife, from the roaming police units, and the violent clearing and demolition operations across the city. The walls of our university separated us as we pored over our textbooks, seemingly far from the social realities that are supposed to inform our medical practice.

Five years ago, I was one of about 160 new medical students from all over the Philippines who were welcomed into Calderon Hall. We were young, aspiring peoples who hailed from the NCR, the Cordilleras, Southern Tagalog, the Panay Islands, Caraga, the Bangsamoro Autonomous Region in Muslim Mindanao  — from some of the most underserved communities in the country. Our diverse and personal stories did not just shape our character as we struggled in medical school, but ultimately became our guide for the kind of physicians we needed and intended to become.

Standing in front of you today, I choose to go beyond the difficulties we faced as UP Med students. Our so-called “med school life struggles” have more or less been our points of discussion across various platforms online and offline. Worse, we have a tendency to romanticize these experiences, as if being a med student was the hardest and most exhausting challenge in the world and yet we have triumphed over it. So to my fellow graduates and to parents and dignitaries here present, allow me to share how the UPCM Class of 2021 really spent their lives in med school the past five years.

The collective understanding of this class, I assume, is that a student is not defined by how quick they learn concepts or how dedicated they are to their academic routine. Written examinations are far from being enough to measure a student’s growth and development in med school.

A good med student does not regard medicine as a mere classroom exercise or a clinical exam to accomplish. A good med student recognizes that the practice of medicine goes beyond the classrooms and hospitals, a practice that inevitably extends to a world where street vendors, contractual grocery store workers and informal settlers fight for survival — a world where the root illnesses of our country are neither biological nor pathological, but are socially-created and enforced.

The worst illnesses of our country are the ones that make us believe that social change is impossible, and that the suffering of millions of Filipinos is inescapable. The worst living conditions is where med students and health workers believe that they have no role in campaigning and fighting for just and lasting peace.

As students, we learn from our studies of medicine. But we also learn from other disciplines, like art. I remember these graduates as the class that, in 2017, staged a play about the fictional peasant community, Santa Isabel, in Mediscene, the annual theater competition of the College of Medicine. In the play, the town was ruled by the dela Marquezas. Dr. Gio Terania Grino, one of our graduates today, played the character of Inigo dela Marqueza who killed peasants to acquire vast areas of land and maintain his family’s power. The town’s celebrated rulers wrecked the lives of the ordinary people, and rendered them incapable of imagining a better world.

This piece depicted the worst irony in Philippine and Bangsamoro societies: our farmers are left with empty plates after spending hours harvesting the nation’s food. They bear the brunt of a feudal system that renders them vulnerable in every setting, from the feudal violence of the rice fields to the inhumane inaccessibility and costs of the hospital.

Once, during my emergency room duty one stormy dawn, an emaciated farmer from Palawan sought consultation due to difficulty breathing from a mass in his esophagus. I learned that he spent what was left in his pockets to ride a jeepney from southern Luzon to Manila. Yet the first thing he did after seeing me was to apologize because he felt like a burden to overworked healthcare workers. The broken system took physical form in front of my very eyes: someone who has fed countless Filipinos travelled for days to seek medical attention and felt like a burden to an establishment that was supposed to take care of him.

Like the town of Santa Isabel, there are countless communities in the country where farmers earn an amount of less than a hundred a day and are left with no health facilities that will attend to their needs. This social illness starves the hands that feed us. With nutrition being the foundation of health, how can we as physicians turn a blind eye to the lived experiences of our farmers? With certainty, this graduating class will leave the halls of Calderon with eyes that do not only see patients as clinical subjects, but as human beings whose lives have been wracked by structural violence.

There is so much to see once one steps out of the college’s gate in Pedro Gil. Manila’s red light district is just down the street where clubs are open until dawn. The work of women on the streets of Malate is no secret to the people in the Metro. In Mediscene 2018, our class portrayed the story of sex workers in Malate and highlighted the circumstances that led them to join the industry. We featured the lives of Delia, portrayed by Dr. Bea Malabag Valdez, and Sisa, portrayed by Dr. Jea Niedo Solidum, who grew up as a street child, entered sex work, became pregnant in the process, and lost her child.

This story is not far from the experiences of sex workers from the metropolitan cities of Olongapo, Iloilo, and Davao. Women, especially transwomen, are coerced into vulnerable situations where they are at risk of physical, sexual, and emotional violence. More so, sexually transmitted diseases are also rampant in areas converted to sex tourism cities. However, their access to health facilities remains a rare topic in the discourse of reproductive health. We have repeatedly read STD chapters from William’s Obstetrics and Comprehensive Gynecology. But we must ensure this knowledge serves the red light districts of Malate and Olongapo, the assembly lines of factory workers, the communities of transgender people who have no access to medical facilities. What is the point of our medical achievement if our hospitals and clinics serve only the privileged few?

We are expected to go into specialized training. Many of us will eventually pursue this track. Mainstream opinion views specialized physicians as the peak of medical practitioners. We must challenge these existing notions. We accordingly envision that today’s graduates will become pediatricians who actively work to change the prevailing conditions that expose the Filipino, Bangsamoro, and indigenous children to significant health risks. According to UNICEF, 95 children in the Philippines die each day from malnutrition. And in one province in Mindanao, 9 out of 10 households of public school children were food insecure.

The future internists of this class will face the challenge of dealing with communicable and non-communicable diseases. It is therefore essential to be concerned with the existing problems of displacement and homelessness, unemployment and contractualization, and inadequate wages, issues which do not appear to be medical conditions but still affect the holistic health of Filipinos. One must recognize that diseases such as tuberculosis remain widespread in overcrowded settlements, in impoverished communities where healthy meals are a luxury, and in our prisons where the majority of convicts are either innocent or are forced to commit crimes because of poverty. Our fundamentally-flawed criminal justice system condemns Filipinos to these tuberculosis-ridden jails. Our flawed economic system banishes the poor and marginalized to a lifetime of health emergencies and preventable diseases.

Our graduates who aspire to become surgeons will encounter gunshot wounds, not just as mere results of trauma needing laparotomies and thoracotomies, but as products of mental illnesses, street violence, and extrajudicial killings. In the past five years, suspected drug dealers have been killed without due process and accountability. These include Kian delos Santos, Carl Arnaiz, Reynaldo de Guzman, and every other victim that has been reduced to statistics. Should medical societies remain indifferent towards these state-sponsored shootings? Even the textbook Schwartz’s Principles of Surgery informs us that “…trauma must be considered a public health issue.” And, just like other public health issues, prevention is better than cure. For this reason, ending all forms of violence will always remain a medical concern.

The past year has challenged the medical field’s social responsibility. The pandemic exposed and worsened the preexisting brokenness of our healthcare system. UPCM has always taught us that inequities in health are always rooted in inequities in life. How can we ensure social distancing when our workers are forced to ride in cramped buses and jeepneys immediately after their shifts to avoid violating a curfew policy set without community consultation? How can we ensure people stay home when in the midst of the pandemic we demolished homes and evicted 120 families in the slum communities of Pasay, 300 families in Cabuyao, Laguna, and 50 families in the coastal area of Paranaque City?

Our leaders claim the pandemic is our great equalizer. But we cannot deny that different social classes have experienced this health crisis differently, and that the poor are always the most devastated by any public health crisis. During lockdown, the rich still travel, the middle-class try new recipes from Instagram, and the poor starve. At the same time, we had a collective realization about the true essential workers of our communities. These are our street sweepers, garbage collectors, grocery store workers, janitors, maintenance staff, public utility vehicle drivers, farmers, the working class who earn poverty wages. They ensured our survival, even as their lives were continuously threatened and endangered by the government’s corrupt and incompetent response to the pandemic.

Despite the failures of the state to ensure everyone’s health and well-being, we give our highest salute to our primary care physicians, the ones who took the road less travelled, who ensured health policies work in specific local and cultural contexts, and who always upheld the principles of primary healthcare. Together with our community nurses, pharmacists, midwives, and barangay health workers, they were at the frontlines in battling this crisis. But we must remember that they have always been there. Even before the pandemic, they were the primary witnesses of the failures and shortcomings of our  healthcare system. They have always engaged with communities, worked to improve health outcomes, and stretched their very limited resources to serve the people largely abandoned by other government and private institutions. Illnesses start in communities, and we are quickly realizing that the future is public health.

To my fellow graduates, as we leave the halls of Calderon and PGH (Philippine General Hospital) and pursue our chosen tracks be it in specialized training, primary health care and public health, research, the academe, or public administration – may we always be reminded of the students we used to be. We were able to ace our examinations and OSCEs (Objective Structured Clinical Examination), case presentations and journal appraisals. But we were also the students who took to the streets when the dictator Marcos was buried at the Libingan ng mga Bayani because we believed historical revisionism was a disease that needed to be confronted. We held the banner that said “Heal the Nation, Fight Tyranny” when we rallied against state-sponsored atrocities and thousands of extrajudicial killings because we believed that drug addiction is a public health issue that fascism never heals. We issued a statement against the Anti-Terrorism Law because we believed that acts of dissent should never be criminalized, especially when it’s targeted at public policies which further burden and endanger the lives of the poor. We left our classrooms when we realized we were needed in the streets.

People claimed we were too radical and that UP indoctrinated us. But UP never radicalized us. We were radicalized by the long lines outside the OPD  (Outpatient Department) at 2am, We were radicalized by insufficient oxygen tanks in the ACU [Acute Care Unit] we were radicalized by  the sight of our patients sitting down or lying on the floor of our hallways, waiting to be admitted. We were radicalized by the fact that every single day, thousands of our healthcare workers seek better job opportunities abroad because of the poor working conditions this country offers them. Our country’s leaders attack our actions, yet their corruption and heartlessness created the conditions of our radicalism.

Classmates, may we find the essence of what it means to be a physician in a country plagued by social illnesses. To be a Filipino, Indigenous, and Moro doctor is to stand alongside our patients in our struggle towards what ensures health for all: social justice. Our white coats and MDs mean nothing if we remain silent in the face of inequalities. My white coat would have meant nothing if I had not learned of the daily life of the Kuya who sold me squid balls and the Ate who made my egg sandwiches. And so, may we not only have clinical eyes that see signs of diseases, but critical eyes that see the signs of violence and injustices in the conditions of the people we meet, the very people whose taxes and labor sustained our medical education.

Let us never lose sight of our goals and continue to allow compassion and empathy to drive our responsibility to serve the underserved.

As Che Guevara: a peoples’ doctor, and prominent socialist once said, “The true revolutionary is guided by great feelings of love.”

Padayon, University of the Philippines College of Medicine Class 2021! Doktor ng Bayan, Paglingkuran ang Sambayanan!

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