How to Use the Newest Vital Signs

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Sample illustration for interpretation by Patient to complete the Newest Vital Sign screening for health literacy Photo Credits: www.medscape.com
How To Use the Newest Vital Sign

1. Who and when to administer the Newest Vital Sign?

           A nurse (or other trained clinic staff) is the preferred administrator of the Newest Vital Sign.

           Administer at the same time that other vital signs are being taken. 


2. Ask the patient to participate.
A useful way to ask the patient is an explanation similar to this:
“We are asking our patients to help us learn how well patients can understand the 
medical information that doctors give them. Would you be willing to help us by 
looking at some health information and then answering a few questions about that 
information? Your answers will help our doctors learn how to provide medical 
information in ways that patients will understand. It will only take about 3 minutes.”
3. Hand the nutrition label to the patient.
The patient can and should retain the nutrition label throughout administration of the 
Newest Vital Sign. The patient can refer to the label as often as desired.
More…
 
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Questions to Ask for Newest Vital Sign http://farm3.static.flickr.com/2622/
The Newest Vital Sign developed by Pfizer along with experts of the University of Arizona College of Medicine. The NVS is designed as a questionnaire with a picture of a Nutrition Label at the back of a pint of ice cream. Patients are asked to interpret what it is.

See Picture of the Nutrition Label used for the test.

The questions asked are the following:

  1. If you eat the entire container, how many calories will you eat? 
  2. If you are allowed to eat 60 grams of carbohydrates as a snack, how much ice cream would you have?
  3. Your doctor advises you to reduce the amount of staturated fat in your diet. you usually have 42 grams of saturated fact each day, which includes one serving of ice cream. If you stop eating ice cream, how many grams saturated fat would you be consuming each day?
  4. If you usually eat 2500 calories in a day, what percentage of your daily value of calories will you be eating if you eat one serving?


The right answers to these questions should be the following

For the first question: 1000

For the second question: Any of the following is correct---1 cup (or any amount up to 1 cup), half the container. (Be sure to clarify if the patient answers "two serving". Ask "How much ice cream would that be if you were to measure it into a bowl?")

For the Third question: 33

For the fourth question: 10%


Once you are through with these four questions, read to the patient or subject the following:

Pretend that you are allergic to the following substances: penicillin, peanuts, latex gloves, and bee stings.

5. Is it safe for you to eat this ice cream?

6. (Ask only if the patient responds "no" to question 5): Why not?

The fifth question should have a "No" answer to qualify as correct.

Lastly, the sixth question should have a correct answer similar to "because it has peanut oil".


Tally the number of correct answers.

Scores of 0-1 suggests high likelihood (50% or more) of limited literacy.
Scores of 2-3 indicates the possibility of limited literacy.
Scores of 4-6 almost always indicates adequate literacy.






 
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More Ways Than One (Photo by: Josh Mahoney)



























Can we really prevent diabetes? My cousin is one we rightly call the “Sweeper” because he is the last man out of the table after meals. He can finish just about everything that is left on the table as long as it is edible.

Regularly, we check his blood sugar and (surprise, surprise) he is way below the threshold for diabetes.

Even those in the medical profession have diabetes. I am most likely to get it with my strong family history, sedentary lifestyle and propensity to de-stress with bingeing. My cousin though, even if he keeps not just his own plate clean, is an avid walker. He walks daily to and from work and just about anywhere he can.

Can we really prevent diabetes? The latest study from the Diabetes Prevention Program Outcomes Study (DPPOS) may hold the answer. The study is a randomized controlled trial that compares long-term diabetes risk of those who achieve normal glucose control (defined as having fasting blood plasma glucose level of less than 100mg/dL and a 2-hour plasma glucose level of less than 140mg/dL) during the Diabetes Prevention Program with those who actually diabetes already that remains uncontrolled.

The study observed the incidence of diabetes and grouped the participants according to their medications and treatment.  Insulin secretion of the subjects and their sensitivity to insulin during the study was also observed.

Remarkable findings of this on-going observational study was numerous and interesting. If a participant achieved normal glucose regulation at least once during the Program, risk for progression to diabetes was reduced to 56%. When a participant achieves normal glucose regulation twice the risk reduction increases to 61% and further increased to 67% if the number of glucose regulation occurs thrice.

These findings point to tweak in our understanding of primary and secondary prevention of diabetes. This research clearly points out that diabetes is preventable and can be further delayed even with attainment of just once instance of normal glucose regulation.

The authors point to one plausible explanation for this significant reduction in diabetes risk which is related to the concept of “beta-cell rest”. Beta cells in the pancreas produce insulin needed to transport blood sugar (glucose) across all cells in need of energy to survive. With the volume of blood sugar in persons with diabetes, the beta cells may have long been exhausted or even depleted. Reaching normal levels, even for brief periods, provide them with the opportunity to “rest” their exhausted beta cells.

In contrast, some point to insulin insensitivity of the receiving cells as a reason why glucose remains in the blood stream instead of going in the cells. This research weighs in on the benefit of rest rather than on insensitivity of cells.

Therefore, it is best that once people who are diagnosed with diabetes should be treated aggressively just so they achieve this window of opportunity for reversing the progression of diabetes just by having “beta-cell rests” once, twice or continually.

Let us all have a wonderful and healthy life ahead! Let us rest our beta-cells and not just sit around moribund.


 

Should We Drink To This?

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Drinking While Pregnant http://www.flickr.com/photos/richdelux/3984997045
Two recent findings have turned the tables for habit-forming drinkers. Recent coffee researches, as we have discussed in this column, have validated numerous health benefits and improvements in well-being of coffee drinkers. The latest to turn the table in the drinking public and health community is with alcoholic beverage consumption during pregnancy.

According to a new study, funded by the Centers for Disease Control and Prevention and published in the June 20 issue of BJOG: An International Journal of Obstetrics and Gynecology, low and moderate drinking during early pregnancy has no adverse neuropsychological effect by five years of age.

This study published by Dr. Ulrik Schiøler Kesmodel followed a sample size of 100,000 women and their children who participated in the Danish National Birth Cohor.  After 5 years, a total of 1628 children were tested for attention, general intelligence and executive function. The mothers were also tested for intelligence.

It is a common belief and widely accepted practice to advise women to avoid vices that include smoking and drug use. The research revealed that children born to mothers who have been drinking 5 or more drinks on a limited number of times during early pregnancy have comparable intelligence, attention and executive function as those who abstained.

This limited consumption pertains to intake between 1 and 8 units of alcohol per week. This comes as a welcome respite for mothers who have been habitually drinking or those who took some shots without realizing earlier that they are actually pregnant. Guilt feelings that come with breaking such long-held precautionary beliefs would be allayed by this result.

The study however points out that consumption of 9 or more units of alcohol per week resulted in children that appeared to have slightly lower IQ levels and poorer attention than children delivered by mothers who abstained from alcohol during pregnancy.

In the United Kingdom, a unit of alcohol is equivalent to 10 milliliters. This can be comparable to a small glass of wine or half a pint of beer (284 ml).

Should we drink to this fact then? I believe that the prevailing wisdom of abstinence is still wiser and apt for the benefit of the mother and child.

The burden for mothers is not just the weight in their belly that they carry for nine months. The emotional upheaval that comes with the uncertainty of how life would progress beyond the womb places a huge burden for the mother from conception onwards.

Some women cannot just cut the habit within a few months. Some women have unplanned pregnancies after a night of partying and drinking. With this research, the issues that pregnant women have to face are now lighter.

 

Are Chinese Medicine Safe?
(Last of Two Parts)

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Traditional Chinese Medicines
How safe and effective are Chinese Herbal Medicine compared to  conventional (“Western”) medicine? With the advent of the global individual and  the liberalization of trade worldwide, the barrier between both traditional  Chinese herbal medicine and conventional medicine is slowly mixed up. 
 
Traditional Chinese herbal medicine is a system  of health care that originated in China for more than two millennia ago.  Just like the Humors expounded by   Hippocrates, the father of Medicine, where four distinct fluids (or humor)   affect the person’s health and temperament, Chinese herbal medicine is grounded on  the concept of harmony in the flow of the body’s vital energy, the “Qi”. Any  imbalance between the Qi or the humors result to disease. 
 
Traditional Chinese medicine is still popular in China. Around  40% of the health care delivered in China is a mixture of conventional and  traditional Chinese medicine. On the other hand, traditional Chinese medicine is  slowly gaining ground in conventional health care practice in the Western  world.

Checking on adverse events in Chinese herbal medicine is a bit  difficult since the trials available for scrutiny are small and face a more  difficult predicament compared to conventional medicine adverse event reporting. 

Afterall, how many doctors actually report adverse events of the drugs they  prescribe? Translate that to thousands of tablets prescribed daily with any  adverse reaction to the medicine barely reaching the table of a physician.

To answer the question of effectiveness of Tradional Chinese  medicine under a scientific eye, one has to utilize scientific methodologies  that will check for biases, errors in methodology, integrity of results, and  matched for their purported clinical are and type of  outcome.

In a study published by Shang and company in the International  Journal of Epidemiology (2007), they found that none of the 136 trial reports of  Chinese Herbal medicine study mentioned change in the medication dose after  patients came in for follow-up and only two trials actually used individualized treatments. This tend to make small studies of Chinese herbal medicine reporting more benefits than larger studies since studies of smaller magnitude tend to individualize their treatment.

The same researcher concluded biases are “most pronounced” in placebo-controlled groups. Adequate data is not available to properly and factually conclude beneficial effects in taking Chinese herbal medicine.

Many people maintain a misguided concept that if it is“herbal” there is no side effect. One obvious case in point that many are not aware of is with Ginseng and Gingko biloba. Both are commonly included in herbal products and has been highlighted in vitamins and other conventional medicine. But unknown to many taking these two herbal substances with blood-thinning agents or for those with a preponderance to bleed actually predispose the user to a
bleeding episode that may just prove fatal.

The principle of “Do No Harm” has to be in our mind always. Not all that glitter is gold. Herbal medicine has to be quantified properly and analyzed scientifically before being qualified as a remedy for something or just about anything.
 

Are Chinese Medicine Safe?

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Traditional Chinese Medicine Preparation http://bit.ly/JwVa1Z
In any given time it is not unusual to find one customer in a pharmacy ask for “medicines” that are not actually registered in the Food and Drug Administration. Some of the most common products that are asked are “Betet” and “Flucinonide”.
 
In a popular Chinese drugstore in the Philippines, one can find an array
of products that have Chinese characters that are beyond the comprehension of  most Filipinos. They are written all over the packaging. To search for the
required BFAD permit number, Lot/Batch No., manufacturing date and expiry date will lead you nowhere. They are simply not there.

If one takes some time people-watching in one of these drugstores, you may find people dropping by to ask the Chinese owner what is good for this particular ailment with such features and accompanied by this other malady. The old man, trying to impress upon the hapless Filipino that he bears the wisdom of the ages (without a degree to back it up), would dispense some products that the native will swallow hook-line-and-sinker!

A recent study conducted at Murdoch University in Australia showed that samples of herbal teas, capsule, flakes and powders from products seized by the Australian border officials revealed that almost 70 different plant families from 15 samples contained toxic materials if taken in the wrong
dose or quantity. 
 
For these products that came without the benefit of Google-translated packaging materials that is so often present in subtitles of pirated DVDs and Chinese products, knowing the right dose, timing of intake, and duration of treatment is at best a simple guesswork.

Other plant agent such as Aristolochic Acid that cause urinary tract and kidney cancer was also found by the researchers. Illegal substance likely ephedra was also found among the seized imported goods.

Human life is not only at risk when consumers go for Chinese medicines. The world’s fauna are also in danger. The Australian researchers found traces of endangered animals such as Saiga antelopes. Labels that bear
these products were also misleading. Touted to be “100% Saiga Antelopes”actually contained goat and sheep DNA.

Some patrons (and matrons) of Chinese medicines are practicing Hindi. Little they know that some products from drugstores selling traditional
Chinese medicine actually contain deer and cow parts.  

One cannot expect that the sales of traditional Chinese medicines will decline in the years to come. Doctors often advise patient to refrain from
taking medicines the pharmaceutical industry, Food and Drug Administration, much less the patient, have little knowledge of. What is often clear is the fact that these products hold little promise to the consumer. The drugstore will continue to sell since it is lucrative. They do not have any ethical principles to govern their business. 

(By the way, I have Chinese blood running through my veins and I
am a businessman, as well.)

 
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Steve Jobs 1955-2011 http://farm7.static.flickr.com/6095/

Must Read! Steve Jobs Graduation Speech


One of the best graduation speeches ever delivered by an entrepreneur was that by Steve Jobs, which he delivered at Stanford University last June 12, 2009. With this transcript I came to appreciate the nature and character of a man that was often reviled by his colleagues for his astuteness, candor, and not-too-graceful approach to criticizing his employees. 

The lessons and nuggets of wisdom he shared are applicable not only to business people like him, but to people from all walks of life. Share this speech with your boss, colleagues, friends and even to young people. Here it is:

"I am honored to be with you today at your commencement from one of the finest  universities in the world. I never graduated from college. Truth be told, this is the closest I've ever gotten to a college graduation. Today I want to tell you three stories from my life. That's it. No big deal. Just three stories.

"The first story is about connecting the dots.

"I dropped out of Reed College after the first six months, but then stayed around as a drop-in for another 18 months or so before I really quit. So why did I drop out?

"It started before I was born. My biological mother was a young, unwed college graduate student, and she decided to put me up for adoption. She felt very strongly that I should be adopted by college graduates, so everything was all set for me to be adopted at birth by a lawyer and his wife. Except that when I popped out they decided at the last minute that they really wanted a girl. So my parents, who were on a waiting list, got a call in the middle of the night asking, 'We have an unexpected baby boy; do you want
him?' They said, 'Of course.' My biological mother later found out that my mother had never graduated from college and that my father had never graduated from high school. She refused to sign the final adoption papers. She only relented a few months later when my parents promised that I would someday go to college.

"And 17 years later I did go to college. But I naively chose a college that was almost as expensive as Stanford, and all of my working-class parents' savings were being spent on my college tuition. After six months, I couldn't see the value in it. I had no idea what I wanted to do with my life and no idea how college was going to help me figure it out. And here I was spending all of the money my parents had saved their entire life. So I decided to drop out and trust that it would all work out OK. It was pretty scary at the time, but looking back it was one of the best decisions I ever made. The minute I dropped out I could stop taking the required classes that didn't interest me, and begin dropping in on the ones that looked interesting.

"It wasn't all romantic. I didn't have a dorm room, so I slept on the floor in friends'  rooms, I returned Coke bottles for the five-cent deposits to buy food with, and I would walk the seven miles across town every Sunday night to get one good meal a week at the
Hare Krishna temple. I loved it. And much of what I stumbled into by following my curiosity and intuition turned out to be priceless later on. Let me give you one example:

"Reed College at that time offered perhaps the best calligraphy instruction in the country. Throughout the campus, every poster, every label on every drawer, was
beautifully hand-calligraphed. Because I had dropped out and didn't have to take the normal classes, I decided to take a calligraphy class to learn how to do this. I learned about serif and san serif typefaces, about varying the amount of space between different
letter combinations, about what makes great typography great. It was beautiful, historical, artistically subtle in a way that science can't capture, and I found it fascinating.

None of this had even a hope of any practical application in my life. But 10 years later, when we were designing the first Macintosh computer, it all came back to me. And we designed it all into the Mac. It was the first computer with beautiful typography. If I had never dropped in on that single course in college, the Mac would have never had ultiple
typefaces or proportionally spaced fonts. And since Windows just copied the Mac, it's likely that no personal computer would have them. If I had never dropped out, I would have never dropped in on this calligraphy class, and personal computers might not have the wonderful typography that they do. Of course, it was impossible to connect the dots looking forward when I was in college. But it was very, very clear looking backwards 10 years later.

"Again, you can't connect the dots looking forward; you can only connect them looking backwards. So you have to trust that the dots will somehow connect in your future. You have to trust in something – your gut, destiny, life, karma, whatever. This approach has
never let me down, and it has made all the difference in my life.

"My second story is about love and loss.

"I was lucky. I found what I loved to do early in life. Woz and I started Apple in my parents' garage when I was 20. We worked hard, and in 10 years Apple had grown from just the two of us in a garage into a $2 billion company with over 4,000 employees. We had just released our finest creation – the Macintosh – a year earlier, and I had just turned 30. And then I got fired. How can you get fired from a company you started? Well, as Apple grew we hired someone who I thought was very talented to run the company with me, and for the first year or so things went well. But then our visions of the future began to diverge and eventually we had a falling out. When we did, our board of directors sided with him. So at 30 I was out. And very publicly out. What had been the focus of my entire adult life was gone, and it was devastating.

"I really didn't know what to do for a few months. I felt that I had let the previous generation of entrepreneurs down – that I had dropped the baton as it was being passed to me. I met with David Packard and Bob Noyce and tried to apologize for screwing up
so badly. I was a very public failure, and I even thought about running away from the valley. But something slowly began to dawn on me – I still loved what I did. The turn of events at Apple had not changed that one bit. I had been rejected, but I was still in love. And so I decided to start over.

"I didn't see it then, but it turned out that getting fired from Apple was the best thing that could have ever happened to me. The heaviness of being successful was replaced by the lightness of being a beginner again, less sure about everything. It freed me to enter one of the most creative periods of my life.

"During the next five years, I started a company named NeXT, another company named Pixar, and fell in love with an amazing woman who would become my wife. Pixar went on to create the world's first computer animated feature film, Toy Story, and is now the most successful animation studio in the world. In a remarkable turn of events, Apple bought NeXT, I returned to Apple, and the technology we developed at NeXT is at the heart of Apple's current renaissance. And Laurene and I have a wonderful family together.

"I'm pretty sure none of this would have happened if I hadn't been fired from Apple. It was awful tasting medicine, but I guess the patient needed it. Sometimes life hits you in the head with a brick. Don't lose faith. I'm convinced that the only thing that kept me
going was that I loved what I did. You've got to find what you love. And that is as true for your work as it is for your lovers. Your work is going to fill a large part of your life, and the only way to be truly satisfied is to do what you believe is great work. And the only way to do great work is to love what you do. If you haven't found it yet, keep looking. Don't settle. As with all matters of the heart, you'll know when you find it. And, like any great relationship, it just gets better and better as the years roll on. So keep looking until you find it. Don't settle.

"My third story is about death.

"When I was 17, I read a quote that went something like, 'If you live each day as if it was your last, someday you'll most certainly be right.' It made an impression on me, and since then, for the past 33 years, I have looked in the mirror every morning and asked myself, 'If today were the last day of my life, would I want to do what I am about to do today?' And whenever the answer has been 'No' for too many days in a row, I know I need to change something.

"Remembering that I'll be dead soon is the most important tool I've ever encountered to help me make the big choices in life. Because almost everything – all external expectations, all pride, all fear of embarrassment or failure – these things just fall away
in the face of death, leaving only what is truly important. Remembering that you are going to die is the best way I know to avoid the trap of thinking you have something to lose. You are already naked. There is no reason not to follow your heart.

About a year ago I was diagnosed with cancer. I had a scan at 7:30 in the morning, and it clearly showed a tumor on my pancreas. I didn't even know what a pancreas was. The doctors told me this was almost certainly a type of cancer that is incurable, and that I should expect to live no longer than three to six months. My doctor advised me to go home and get my affairs in order, which is doctor's code for prepare to die. It means to try to tell your kids everything you thought you'd have the next 10 years to tell them
in just a few months. It means to make sure everything is buttoned up so that it will be as easy as possible for your family. It means to say your goodbyes.

"I lived with that diagnosis all day. Later that evening I had a biopsy, where they stuck an endoscope down my throat, through my stomach and into my intestines, put a needle into my pancreas and got a few cells from the tumor. I was sedated, but my wife,
who was there, told me that when they viewed the cells under a microscope the doctors started crying because it turned out to be a very rare form of pancreatic cancer that is curable with surgery. I had the surgery and I'm fine now.

"This was the closest I've been to facing death, and I hope its the closest I get for a few more decades. Having lived through it, I can now say this to you with a bit more certainty than when death was a useful but purely intellectual concept: No one wants to die. Even people who want to go to heaven don't want to die to get there. And yet death is the destination we all share. No one has ever escaped it. And that is as it should be, because Death is very likely the single best invention of Life. It is Life's change agent. It
clears out the old to make way for the new. Right now the new is you, but someday not too long from now, you will gradually become the old and be cleared away. Sorry to be so dramatic, but it is quite true.

"Your time is limited, so don't waste it living someone else's life. Don't be trapped by dogma – which is living with the results of other people's thinking. Don't let the noise of others' opinions drown out your own inner voice. And most important, have the courage to follow your heart and intuition. They somehow already know what you truly want to become. Everything else is secondary.

"When I was young, there was an amazing publication called The Whole Earth Catalog, which was one of the bibles of my generation. It was created by a fellow named Stewart Brand not far from here in Menlo Park, and he brought it to life with his poetic touch. This was in the late 1960s, before personal computers and desktop publishing, so it was all made with typewriters, scissors, and Polaroid cameras. It was sort of like Google in paperback form, 35 years before Google came along: It was idealistic, and overflowing
with neat tools and great notions.

"Stewart and his team put out several issues of The Whole Earth Catalog, and then when it had run its course, they put out a final issue. It was the mid-1970s, and I was your age. On the back cover of their final issue was a photograph of an early morning country road, the kind you might find yourself hitchhiking on if you were so adventurous. Beneath it were the words: 'Stay hungry. Stay foolish.' It was their farewell message as they signed off. Stay hungry. Stay foolish. And I have always wished that for myself. And now, as you graduate to begin anew, I wish that for you.

"Stay hungry. Stay foolish.

Thank you all very much."
 
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Be On Time http://farm3.static.flickr.com/2403/
Juan Time


Jim Paredes and other personalities recently campaigned to make every Filipino aware of the Philippine Standard Time. Filipino cable channel viewers can see the nice ad placed in National Geographic. Those without one must have viewed the news clips provided by most media groups.

How big a problem is this? Many would easily scoff at the notion that Filipinos can actually develop the capacity to be on time. I have interacted with foreigners who find their meetings here delayed not just for minutes but even hours! All the while they are left to sit and wait for others to come. Some would set the meetings in "advance" for 30 minutes. This leaves the hapless punctual person coming earlier and waiting for the rest who would eventually come an hour later.


Patients are also prone to coming in late as well as their doctors. On many occasions I have witnessed childbirth in hospitals where the attending Obstetrician is late with the baby's head already protruding and the resident doctors trying to make the mother stop bearing just so the attending doctor can deliver the baby him/herself. On other instances, the baby can no longer be kept from its natural demands and are simply delivered without the doctor. The resident doctor's recourse will then be to leave the placenta in the pelvis until the attending doctor arrives. All the while the mother is lying on the delivery table cold, exhausted and anxious about what is happening (or, in this case, what is not happening) between her legs.

Every second counts thereafter. A baby delivered sooner or later than the expected date or time of delivery may have grave consequences. Premature babies are at risk for survival and if they do survive are at risk to thrive later in life. Babies who are delivered late are also at risk for infection and other delivery problems. They may be too large for the mother to safely allow in her canal.

Thereafter, life may then be a continuum for many. For others, every second becomes more precious. Every breath counts, every milliliter of oxygen in the tank becomes important and expensive, each tablet of medicine has to be taken at the proper time. Some may miss their pill and life can then be conceived.

But is a Filipino perennially late? Are we facing an untreated behavioral disorder? Punctuality is indeed a real, tangible problem for many Filipinos that addressing it cuts through the most important and expensive resource we have as a country. If our punctuality problem cannot be addressed who will do business with us? If I am a foreign investor and Philippine Stock Exchange does not operate with precision, I would hesitate to invest in this country who cannot get their life in order and on time.

If I am a patient I would rather find a doctor who have the time for me. If I am left waiting for hours at the doorstep of his/her office for hours waiting for him/her to arrive, how does that speak of his/her professionalism and quality of care? 

On the flip side, If I am a doctor and my patient sets an appointment and arrives late, what does that mean to me? It means total disrespect for my practice, my office schedule, my life, my family and all other patients who have been bumped off the schedule taken by the patient who comes late. 

Time is a precious resource that cannot be saved nor deposited in the bank for future use. It has to used properly now and always. Medicine operates with precision instruments around the hospital and doctor's clinic. This precision instrument should include the wall clock and the wrist watch for the practitioners, office personnel, hospital staff and patients.

Changing our attitude about time should be now. Let us get our lives in order.
 
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Health Workers Certify  Virginity of Prostitutes


Wikileaks, the international non-profit organization that publishes private, secret, classified documents have been vilified and praised at many corners of this world. Detractors would say that it opened a Pandora's box that may appear good at the outset but may just unleash something beyond the control of anyone. Its few supporters---New York Times, The Guardian, El Pais, and Der Spiegel---were angered in recent weeks as Julian Assange, the Wikileaks founder, allowed unredacted publication of materials that these media outlets specifically censored. 

The unredacted materials of United States Embassy cables included numbers of key Vatican officials, names of victims of sex offences, people persecuted by the US government and other sensitive materials such as secret US facilities. 

Whether offensive or not the reports provide readers with insights that are mind-blowing for some and mundane for locals. 

Recently, however, an embarrassing report that is beyond the public eye pointed to misdeeds within the Philippine health care system. Wikileaks revealed cable reports made by Kristie Kenney regarding the collusion among health workers and syndicates running prostitution dens.

Government health facilities provided prostitutes with certificates that they are virgin. The certificate enabled the handlers, mamasan (bugaw), with a leverage for better negotiations. In a country that holds in high esteem virginity (and yet never bats an eyelash on prostitution and the practice of "bunyag"), a virgin peddled in the streets can fetch for a better price.

The Wikileaks data also revealed how local government enforce the law against prostitutions (which is illegal in the country, by the way). With the aid of the local police units, sex dens, bars, motels, pimps and prostitutes are "protected". Owners of these facilities give protection money thus allowing them to avoid arrests. Only prostitutes are rounded up.

The protection provided by the government not only serves their personal agenda but also that of the wider socio-economic cycle. Prostitutes enable a segment of the economy and tourism to move forward. By ensuring the "health" of the community and the prostitutes through the Social Hygiene unit, the beauty of the Philippines and the tourism industry is kept at its prime.

It is unnerving how the health sector is dragged into this but it surely has an obligation to the public regardless of occupation and orientation. Sadly this has been exploited by scrupulous sectors.  The tolerance exhibited by the government and the general public over the proliferation of illegal sex trade and the requisite human trafficking that comes with this practice should be stirred by media outlets and rightly so by Wikileaks.