Protect your Peace

 

Bayang Pilipinas Ginigiliw

Happy Philippine Independence Day!

Be Grateful!

June is PRIDE month and the KAAMBAG Clinic prepared a strategic program for BEYOND THE RAINBOW: A Deep Dive into Mental Health, Disclosure and the LGBTQIA Journey - the 2nd KAAMBAG Postgraduate Course.

This crucial postgraduate course on PRIDE Month and HIV awareness delved into these important topics, fostering understanding and promoting positive change.

The Department of Health (DOH) has called for a national public health emergency declaration due to a 500% surge in HIV cases in the Philippines. This rapid increase, reaching 57 confirmed cases per day between January and March, is the highest in the Western Pacific Region. The DOH is also urging the public to get tested, emphasizing the importance of free, confidential testing. Additionally, the DOH is recommending various preventive measures, including the use of condoms, lubricants, and pre-exposure prophylaxis (PrEP) to curb the spread of HIV.   95% of all PLHIVs are male with male-to-male sex driving this HIV epidemic.  This statement may or may not trigger stigma and discrimination against the LGBTQIA community, but this is a fact based on the DOH National Epidemiology Bureau HIV/AIDS and ART Registry.

By highlighting the significance of PRIDE Month and HIV awareness, we are setting the stage for a meaningful learning experience.

We will be exploring the current health status, stigma and rights of the LGBTQIA+ community and the challenges they face in their gender-affirming journeys, as well as the access to these communities with strategies for promoting inclusion and prevention, treatment of HIV infection and care and support for people living with HIV (PLHIVs).

IMPORTANCE OF COLLABORATION

This course is a collaborative effort, and we look forward to hearing from the participants, sharing their insights through the comment section of this Facebook LIVE program on several burning questions:

1. How do we celebrate PRIDE MONTH to promote inclusion and genuine acceptance of LGBTQIA+ rights to health, dignity, respect and love?
2. Accepting that male-to-male sex is the key driver of this HIV epidemic is the first step to finding ways to halt HIV transmission.  How do you love the sinner but hate the sin?  How do you be gentle but firm, knowing that while they continue to have sex, you want them to have SAFE SEX.
3. Having new methods of prevention in our armamentarium for HIV treatment hubs and primary HIV care centers like pleasure-based messaging, condoms, lubes, PrEP and self-test kits, how do we implement effectively considering that knowing is not enough?
4. Research shows that although social media and mobile apps facilitate hook ups, Grindr users are more open to HIV prevention measures.  Therefore, HIV program implementers should be where our patients are, and they are online!

The morning session was enlightening about the health status and rights of LGBTQIA+ in the Philippines, self-stigma, pleasure-based messaging and the psychosocial challenges of gender-affirming journeys.  There are gaps in the health system with need to provide access for the LGBTQIA communities.  There should be a paradigm shift in how we approach patients within the spectrum from using fear of HIV transmission as motivation for uptake of preventive measures to pleasure-based messaging, accepting that sexuality is part of health.

The early afternoon session focused more on MEDICAL aspect of managing LGBTQIA and PLHIVs:  Healthcare Needs of LGBTQIA+; Sexual and Social Network Testing as an innovative approach to reaching taboo populations for increased HIV testing, as well as the routine laboratory tests to screen for ARV toxicities and opportunistic infections.

The late afternoon focused more on the pharmacologic innovation of the 3-in-1 pill with dolutegravir-based ARV regimens, the need for ARV adherence and when to offer pre-exposure prophylaxis and post-exposure prophylaxis.  These topics enhanced the health literacy of our PLHIV patients.

 

Philippines HIV Epidemic: A Public Health Emergency Call

HIV/AIDS Surveillance Report for the first quarter of 2025

The Philippines is currently facing a severe public health crisis.  While initial panic-inducing reports were about MPox cases in selected areas in the country, these index cases were found to be among immunocompromised hosts with multiple sex partners.

This week, DOH Secretary Ted Herbosa sounded off the alarms that the HIV epidemic is even more problematic than mounting fears about MPox due to the more than 500% increase in HIV case findings from 2010 to 2025, based on the DOH National Epidemiology Bureau HIV/AIDS Surveillance Report for the first quarter of 2025.  This prompted the DOH to call for the declaration of a national public health emergency to mobilize resources and intensify intervention efforts. 

Here are the key findings:

1. Dramatic increase:  From January to March 2025, the Epidemiology Bureau recorded 5,101 newly diagnosed HIV cases with 57 new cases detected per day.  Compared to 2010 statistics, this represents 564% increase, making the Philippines the country with the fastest-growing HIV epidemic in the Western Pacific region. 

https://web.facebook.com/DOHgovPH

2.  Youth Most Affected:  Although half (74,081, 50%) of cases were 25-34 years old and 44,187 (30%) were among the youth aged 15-24 years old, the increase is most pronounced among the 15-24 years old age group with some reports indicating a 500% rise in cases.  The youngest reported was a 12 year old from Palawan.

https://bit.ly/HASP2025Q1

3.  Predominant Mode of Transmission:  Although there are people who inject drugs in Central Visayas who get HIV, sexual contact remains the primary mode of HIV transmission, with a significant shift towards male-to-male sexual contact since 2007.

https://bit.ly/HASP2025Q1

4.  Total Cases:  As of March 2025, the cumulative number of reported HIV cases in the Philippines since 1984 is 139,610 (55% of the estimated) PLHIVs who have been diagnosed or laboratory-confirmed, and are currently living or not reported to have died. Further, 92,712 (66% of the diagnosed) PLHIV are currently on life-saving Antiretroviral Therapy (ART), of which, 41,786 (45%) PLHIV have been tested for viral load (VL) in the past 12 months. Among those tested for VL, 36,630 (88%) were virally suppressed.  The latest Philippine HIV estimates show that by the end of 2025, there will be 252,800 estimated People Living with HIV (PLHIV) in the country.  If left untreated, by 2030 there will be an estimated 400,000 PLHIVs who will need anti-retroviral drugs provided by government funding.

https://bit.ly/HASP2025Q1

5.  Advanced HIV Disease at Diagnosis: Reporting of Advanced HIV Disease (AHD)17 cases only started in 2011. Among the total reported cases, 41,550 (29%) were diagnosed with AHD, 8% higher compared to the same quarter of the preceding year.  Advanced HIV Disease at the time of diagnosis indicates delayed testing and treatment.

https://bit.ly/HASP2025Q1

6.  Funding Challenges:  On January 20, 2025, the Trump administration issued an Executive Order freezing all foreign assistance funds for 90 days, citing the need to align programs with the administration's foreign policy priorities.  On January 24, 2025, the U.S. Department of State sent a cable to all U.S. Embassies ordering the immediate suspension of all foreign assistance.  This "Stop Work Order" halted funding for programs including the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) with significant impacts on HIV prevention, treatment, care and support.  

Join us tonight on #HealthXPH at 9PM on BlueSky to discuss this public health emergency call:

T1.  What do you think are the causes and contributing factors to escalating the HIV epidemic in the Philippines?

T2.  With a national public health emergency declaration for HIV, what government response would you recommend to address this crisis?

T3.  What is the role of social media for a comprehensive and multi-pronged approach to halting HIV transmission?

Dare to Risk

Dare to be different.

Dare to try.

Dare to be bold.

9 Life Lessons

 Life Lessons from a Comedian

https://www.facebook.com/share/v/1Bk91te6hz/

Basics of Menstrual Health

I gave a lecture on the Basics of Menstrual Health for the Philippine Society of Public Health Physicians and the AIDS Healthcare Foundation, in celebration of the 2025 Menstrual Hygiene Day on Mau 28, 2025.

Someone told me that we should be giving this lecture to adolescent girls in schools to teach them about sex and how to prevent STIs and HIV.  I think that is really a good idea, but it should be more of a program and a partnership with DepEd and schools rather than just projects and spur of the moment invites.

Wants

I have an ideal guest room with a Murphy bed behind bookshelves or study desks...

 

However, first I need to have a house where I can have a guest room...

Healthcare Leadership

 

Healthcare Leadership is different from other forms of leadership considering that the patients' life depends on how the team works efficiently, systematically and effectively.  Because leaders can only do so much, leaders need to learn the crucial skill of delegating the right task to the right staff at the right time all the time:

Pain and Suffering builds RESILIENCE among Healthcare Professionals

In our hospital, there is a problem of the decreasing number of applicants for residency training, particularly in pediatrics.  I've heard it said before that the new generation of doctors (those who were trained virtually during the COVID-19 pandemic) lack grit and resilience.  They stay away from discomfort and inconvenience and from traumas and rigors of residency training. So they are looking for alternative careers that are available to them.

This is why I would like to talk about RESILIENCE and how we develop resilience among the younger generation.

T1.  How do healthcare workers exhibit resilience?

What is resilience?

The US Department of State defines RESILIENCE as the ability to successfully adapt to stressors, maintaining psychological well-being in the face of adversity.  It's the ability to "bounce back" from difficult experiences.  

Ian Robertson questions whether in today's culture we are reinforcing a "mental illness" mindset rather than fostering resilience and building "mental wellness".  Pain is your friend, so embrace pain for resilience.  "Resistance + pain = degree of human suffering" is the pain paradox.  Resisting or avoiding pain leads to more suffering.

To develop resilience, we must learn to lean into pain rather than avoid it. Embrace pain as if it were a trusted companion. By fostering a new relationship with pain, it begins to shift and become more manageable. 

This chat topic was inspired by a reel I came across on facebook of the NVIDIA CEO saying "I wish upon you ample doses of pain and suffering..."

https://x.com/joshuapliu/status/1769439388155482606

I understood then that the lack of resilience among the younger generation of healthcare professionals is because our parents shielded us from trauma, pain and suffering.  However, overcoming pain and suffering is how we develop resilience, and resilience is critical to success!  Therefore, in order to develop resilience, we need to overcome pain and suffering.  

The thought struck me again when I heard my mother listening to promotions about oud oil production from agarwood.

The speaker was saying that agarwood is a simple tree, and hardly valuable.  It is when agarwood is injured and inoculated with a fungal pathogen that it creates a resinous wood chips where oud oil comes from, which is valuable for fragrance, more expensive than gold.  It is the pain and suffering of the agarwood that makes one more valuable.

It makes sense because an oyster needs the irritation of a stone to produce a pearl.  Carbon undergoes intense pressure in order to become a diamond.

Residency training is tough because one day the discipline that we learn from training will spell the difference between the life and death of our patient.

T2. How do we develop resilience among our healthcare professionals?

Natalie Franke shares five simple steps to build resilience:

1. Nurture a positive view of yourself
2. Move toward your goals
3. Take decisive actions
4. Accept that change is a part of living and be willing to innovate
5. Make connections

The challenge stil boils down to BALANCE - with all the talk and importance of work-life balance and being mindful of mental health, how do we make sure we are providing amples doses of pain and suffering for our healthcare worker trainees to develop not only resilience but also GRIT?

T3. How do we balance developing resilience through pain and suffering while uplifting mental wellness?

References:

1. US Department of State Diplomacy in Action at https://2009-2017.state.gov/m/med/dsmp/c44950.htm#:~:text=Resilience%20refers%20to%20the%20ability,have%20or%20don%27t%20have

2.  Ian Robertson, October 24, 2025.  The Benefits of Pain and Suffering: The Key to Developing Resilience at https://ianrobertsontherapycounselling.com/our-blog/benefits-of-pain-and-suffering-developing-resilience/

3.  Natalie Franke, November 11, 2019.  Five simple steps to build resilience at https://nataliefranke.com/2019/11/5-simple-steps-to-build-resilience/

Sleep Hygiene

I have difficulty sleeping.

I've always been a night owl most of my professional life.  I am most productive from 6pm to 10pm.  Somehow, when menopause hit, I had difficulty sleeping before 12 midnight.  Some nights I watch the clock chime 5am to meet the sunrise.

I looked up Sleep Hygiene for tips on how to get better sleep.  One tip stuck to me, is the last line that you don't use your bed for anything but sleep and sex.

Body Odor Stinks

It feels depressing when your own team talks about you behind your back, when they only see your bad side and feel that you are just there to make work and life complicated for them.  It becomes difficult when your team is not rowing in the same direction.  Worse is when this is all an open secret, and everybody knows all this except you.

It's like body odor.

Everybody can smell it and they just laugh at you without you getting in on the joke.  People make all sorts of memes and jokes and have fun at your expense, because nobody cared enough to take you aside and tell you what the problem was.  Other people don't know how to tell you so you wouldn't get offended.  Other people don't know how to tell you so you don't get hurt.  

The truth hurts.  You're not perfect.  When you have a blank white page, the one that draws your attention is that tiny black dot - the imperfection.

All my life I had difficulty fitting in because I always felt like an ugly duckling.  In high school I had to endure bullying and rumors about me because I was  different and I came from another school.  I know how it feels to be vulnerable, knowing that others had the power to hurt you.  I know how it feels to be rejected, when you're always the last to be picked when joining teams. 

The coping mechanism is to develop a hard shell to protect you from ever being hurt again.  Or you can continue to risk yourself to vulnerability in the hopes of opening up to being accepted for your own true weird self.

Career Choices: what influenced you?

I would like to share some of my thoughts with regards to the questions for tonight's #HealthXPH tweetchat on career choices:

T1. What specialty/field are you in, and what is the most interesting thing about this field for you?

Doctor for all seasons.  I am an obstetrician-gynecologist.  We take care of women.  This is like taking care of the whole family since the woman is the pillar and the light of the home.  

Mobilizer.  The training in OBGYN requires you to coordinate and work in multi-disciplinary teams because we need to make sure our patient gets what she needs:

During childbirth, we need the nurse or midwife and the pediatrician.

In gynecologic surgery, we need the anesthesiologist, the surgeon, the internists, the OR nurses and even the orderlies.

In women protection, we need to coordinate with social workers, police and community advocates.

Clinician.  OBGYNs hold clinics for women from womb to tomb, providing outpatient care and performing office procedures.  The OBGYN is involved with diagnosis and management of reproductive health diseases. 

Surgeon.  An OBGYN is a surgeon with surgical procedures involving the female reproductive tract, with cesarean section as the most common major surgical procedure.  As the saying goes, a good surgeon should have an eagle's eye, a lady's hands and a lion's heart.

Public Health Advocate.  As empowered women empowering women, OBGYNs promote health and wellness, screening and early diagnosis for early prevention.  Maternal health is always a priority in healthcare because of its impact in public health.

Researcher.  As women's health is considered a public health issue, maternal health and reproductive health is always included in research priorities.  Being an OBGYN allows me to participate in research activities.

T2. What inspired you to go into this field? What fueled your enthusiasm?

Aura.  I was rotating in Fabella hospital as a clerk when I first assisted a normal vaginal delivery.  The parturient was having twins.  Despite not really knowing what to do, I was calm and patient, which the patient appreciated amidst the pains of labor.  The assisting midwife told me that I had the "aura" of an OBGYN...  At that time, I had my eyes on a surgical residency, but the observation stayed with me until the day I had to finally decide on my residency application.

Flexibility.  Ultimately, I envisioned that I would like to have my own clinic, make an impact on community health and be able to perform surgery.  I realized that obstetrics and gynecology ticked off all the items on my checklist, and comparing how prim and proper "amazon" OBGYNs presented themselves during conferences compared to the rugged surgeons, I chose to pursue my residency in obstetrics and gynecology, and later on a fellowship in infectious diseases (but that's another story altogether).

Empowerment.  Today, I am fortunate to be able to do what I love to do.  When I finished fellowship training and transferred to Cebu, my grandmother ordered me to rest and not work for a few months.  Then I got bored.  I asked permission from Dr Helen Amorin to volunteer to go on duty at the labor room doing labor watch.  It was something that felt natural to me, to simply be present and lend support to women amidst the pain of labor, coaching them that difficult roads lead to beautiful destinations.  There is light at the end of the tunnel and that after experiencing horrific pain is the joy of holding one's baby.  We are blessed to participate in the miracle of birth, taking care of women from womb to tomb.

Stigma Reduction.  Imagine delivering also women living with HIV.  In addition to the challenges of pregnancy itself, they need to deal with stigma and discrimination.  As empowered women, we empower these women to claim their own rights and to ensure that they get the treatment, care, and support they need for themselves and for their children.

Administration.  Amidst the hustle and bustle of the COVID19 pandemic, I was somehow dragged into hospital administration unintentionally.  The skills of coordination and facilitation and organization that we need in obstetrics and gynecology is also useful in managing institutions and health facilities in general.  Although this was unplanned and God seemingly led me into this, I am glad that I am able to make a contribution towards strengthening health systems.

T3. What advice can you give to someone who is still starting a career in your field?

Know your WHYs and choose something that you love doing so that there will be joy in your work.  If not, then find out what is NEEDED in your area so that you can strategically contribute to nation building and improving healthcare service delivery, because the country needs quality healthcare.  The Filipinos deserve quality healthcare service delivery.

In the end, we should remember that being a doctor is more than a job, it is a vocation.  Medicine is more than a career, it is a love for humanity.  The relationship with patients is based on trust.  We studied as best we could in med school because we knew that one day what we learned could spell the difference between life and death, and that the patient's life would be in our hands.  Choose your career based on what you do best, based on what is needed the most and based on what your heart desires.

Employee Empowerment

 

Employee empowerment is getting employees to do what needs to be done rather than just waiting and doing what they are told.  Empowerment is an act of building, developing and increasing other people's power through cooperation, sharing and working together to develop their COMPETENCY (knowledge, skills and attitudes).

It takes a level 5 leader to authentically empower their team to surpass you to reach their full potential.  It takes self-awareness, self-effacing and humility to genuinely empower one's employees.

Zig Ziglar Theory identified a list of seven steps associated with goal setting, identification, benefits, obstacles, skills, people, plan and timelines.

A stretch assignment is a project or task that challenges an employee to go beyond their current skills set and experience fostering growth and development by pushing them outside their comfort zone.

Situational Leadership

Situational Leadership is an approach where the leader matches and adapts behavior with the needs, commitment, capability and maturity level of his individual employee or team.

Leadership POWER

I was tasked to attend the Civil Service Commission Supervisory Development Course Track 2 and I share the nuggets of wisdom and learnings.

POWER is the prime mover of people and events, the ability to make things happen the way you want to.  The essence of power is influence over the behavior of others.

POWER is the ability to lead and inspire based on TRUST, respect and wholehearted commitment freely given and earned.

Impending Sense of Gloom

 

"There are days when your life clouds over and the world gets so dark, that all at once you can't tell night from day..."  this song from Miss Saigon seems to echo in my ears.

There are days when I do feel thankful for waking up to another day filled with hope and renewed opportunities but somehow I have difficulty finding the motivation to get up and do anything.  What's the use of giving it your best if tomorrow you will probably die anyway?

This is the problem with transitions - some transitions may be painful, because change is not easy.  Whether it's the transition from a child to an adolescent, from an adolescent to adulthood, from singlehood to married life, from nulligravid to primipara, from menstruating to menopause.  All through the life cycle there are changes which are affected by biological, emotional, psychological, social and mental factors.

I've been struggling with the effects of menopause like insomnia, musculoskeletal pains, vasomotor symptoms like hot flushes, headaches and even depression.   I am not one to take medications, as much as I can avoid it... So I take things one day at a time, accepting these transitional changes as part of life. 

While others talk about quiet quitting and giving only the minimum compliance to keep from getting fired, I have always used work as a clutch.  Work has become a coping mechanism for me to keep me pre-occupied and distracted from the silence that somehow has become so frightening that I am at risk of being enveloped in the darkness and swallowed whole by an overwhelming sense of gloom.  Are these thoughts suicidal ideations?  I cannot be sure.  I keep thinking and praying for death... "for in that sleep of death what dreams may come, when we have shuffled off this mortal coil, must give us pause..."

In that terrible silence, I hear the small voice that whispers to Lola Sising that I just want to be a good girl.... but all the wounds and scars from battles both mental, psychological and social, add to that overwhelming oppression of need and longing and rejection. 

Quiet Quitting in Healthcare

Minimum compliance is not enough when you aim to provide quality healthcare because health is wealth and lives of patients are at stake.  So what happens when the healthcare professionals and managers face the phenomenon of "quiet quitting"?

Pyramid of Quiet Quitting

When an employee suddenly leaves our work chat groups for no reason, I asked if she was ok and she simply said "I'm ok, but there are just too many chat groups." then she laid low on work activities, not exerting much effort or engaging co-workers in improving the system.  

When I searched Google Generative AI about this, I discovered a new term called quiet quitting.

QUIET QUITTING refers to employees disengaging from their work by doing the bare minimum to maintain their jobs, without explicitly resigning, and often as a sign of dissatisfaction or burnout.  This can lead to decreased productivity, reduced innovation, and a decline in employee morale.  Signs of quiet quitting include not volunteering for extra projects or leadership roles, limited participation in meetings or team discussions, refusing to take on tasks outside of the job description, arriving late or leaving early, focusing on the minimum required to keep the job.  Quiet quitting can be addressed by improving employee engagement and morale, providing opportunities for growth and development, encouraging open communication and feedback, addressing burnout and stress.

Heather Whitney  writes in her blog Quiet Quitting: Meaning, Signs, and How to Prevent it that in a survey they conducted, the majority of quiet quitters said their manager affects their work ethic (57%), as does their mental health (55%) and compensation (51%). 

Gray Towers says that quiet quitting offers both opportunities and threats for talent acquisition teams.  "their loss is our gain" if quiet quitters are enticed to apply in your company.  However, if the reasons for quiet quitting still pervades in the work place, these quiet quitters can be the reason to need recruiting in the first place.  Bottom line is that employers should have a good employee engagement program.

T1.  How do you understand the concept of "quiet quitting" in healthcare workforce?

T2.  How do you think the concept of quiet quitting affects work-life balance and healthcare service delivery?

T3.  What factors do you think impact work ethics of healthcare professionals?

Transitions

I was searching Google about "transition clinics" considering that we have an adolescent health clinic that helps patients transition to the adult clinics...

Patients attending antenatal clinics are preparing for the transition from being single and available to experiencing motherhood.

I wish there were perimenopausal clinics as well to prepare women to transition to menopause, because now I am experiencing a lot of symptoms like aches and pains and difficulty sleeping.

According to Google AI, transition clinics provide specialized care and support to patients as they move from one stage of treatment of care to another such as from pediatric to adult care or from hospital to home, focusing on medical, practical and emotional needs.

T1.  What transitions in health have you experienced, and how has it affected your life so far?

T2. Do you think these health transitions are severe enough to warrant transition clinics?  Why or why not?

T3.  What practical health tips can you offer for patients undergoing health transitions?