CLINICAL MATTER

During our family vacation to the US, I snuck in a bit of business. Since I was bringing my son to visit his birthplace in Cleveland, I informed my colleagues at the University Hospitals of Cleveland/Case Western Reserve University, where I trained in Infectious Diseases, that we would be in town. Dr. Robert Salata, chief of infectious diseases during my fellowship days, is the current chair of medicine. He invited me to give grand rounds. Getting invited to give grand rounds in the program you trained in is a big deal for physicians. It is an affirmation that the work you have done as a graduate of the program is worthy of recognition from your former teachers. As a foreign medical graduate, who trained in a US-based program, being asked to give a lecture to my former attendings was a singular honor given to very few alumni. For grand rounds, I spoke about our Philippine Covid-19 experience and how we convinced the government to follow the scientific evidence throughout the pandemic. I talked about how it was so important to get the politicians to decide on the correct course of action and how the early lockdown in the Philippines saved hundreds of thousands of lives. My talk focused on how communication is an essential skill for physicians and scientists to guide and properly advise those who have the power to make decisions. I spoke about how I decided to help the government after the Department of Health asked me to be a member of the Technical Advisory Group. *With Dr. Robert Salata, chair of the Department of Medicine at University Hospitals of Cleveland Medical Center/Case Western Reserve University after Gran Rounds by the author.*
Despite not being politically aligned with the Duterte administration, I readily said yes because I knew they needed my help to respond to the crisis. I pointed out how many of us scientists and advisers, who tried to help, were unfairly and viciously attacked by anti-vaxxers as well partisan trolls with nefarious agendas. Finally, I presented the final tally of our response at the time of my talk—4,155,031 total cases, 66,481 total deaths, 36,931 cases/million (155th in the world), 591 deaths/million:(130th in the world). In contrast, these are the US numbers: 107,229,041 total cases, 1,167,220 total deaths, 320,331 cases/million (59th in the world), 3,487 deaths/million (15th in the world). Our numbers are nearly 10 times less the number of cases per million and nearly seven times less the number of deaths per million compared to the US. Even if we compare excess deaths to historical controls to take into account testing disparities, the difference in Covid-19 deaths remain significantly large. The audience, including my former teachers, were duly impressed by our pandemic response. I told them it clearly wasn’t an issue of knowledge, expertise, or resources. As my former ID fellowship teachers, I learned pretty much everything I know about infectious disease from them. The US has some of the finest minds in public health and medicine and these were all available to the US government. Our resources are paltry compared to theirs. Rather, it was the choice of our government to listen to the experts and implement science-based policies that turned the tide. *Dr. Michael Lederman and the author.*

In addition, the Filipino people readily embraced our science-based policies. They wore masks not just to protect themselves but to protect the most vulnerable around them. They readily took the vaccines despite anti-vaxxer rhetoric and attempts by partisans to discredit Chinese vaccines, which turned out to be just as effective as Western vaccines in preventing severe disease. They got boosters when the government made these available to temper the Delta and Omicron waves. And they were amazed when I told them that more than two-thirds of Filipinos continue to wear masks despite these being optional in order to protect the elderly and those at highest risk. The recent entry of XBB.1.16, also known as Arcturus, barely caused a bump in hospitalizations and it never took over because of our continued adherence to masking. Finally, the strong partnership of the government with the private sector was a major factor in finding the needed resources and in keeping morale up during the darkest days of the pandemic. Aside from providing much needed PPE, we never lacked for food in the trenches. In fact, there might have been a bit too much food. As Filipinos, we show care by feeding and I half-joked that I knew that some of our doctors and our laboratory staff gained a bit of weight from all the care packages we were sent. Aside from grand rounds, I had one-on-one visits with some of my Cleveland colleagues. Some of them have become world leaders in their respective fields. I hosted Dr. Robert Bonomo in the Philippines last May, when he was a plenary speaker at the Philippine College of Physicians annual convention. Dr. Bonomo is a world expert on antimicrobial resistance and we reconnected since he is very interested in helping out the Philippines with our challenges with antibiotic resistance. One particularly successful colleague, Dr. Federico Perez, was my junior during fellowship and is a rising star in infectious disease. He is quite interested in working with us in the Philippines after having previously visited and seen our setup at the Philippine General Hospital. Dr. Salata was quite supportive of continuing academic ties and he brough me with him on chairman’s rounds, where we discussed difficult cases with the ward teams. I met up with the long-time program director of the medicine residency program, Dr. Keith Armitage, who is one of the most brilliant diagnosticians I know. I also met up with other colleagues, fellows, and residents and had very engaging exchanges with them. But perhaps the most poignant reunion I had was with my HIV mentor, who has since retired from active practice, Dr. Michael Lederman. Those who know me from my infectious diseases fellowship days from 2005 to 2008 know that I was not all that interested in HIV. This was because I intended to return home after fellowship and there wasn’t really much HIV in the Philippines at that time. Dr. Lederman invited me to do research at his laboratory, world renowned for its immunology work but I turned him down flat. I told him there was no HIV back home and I’d rather focus on tropical medicine. I later found out that Dr. Lederman invites very few fellows to work with him so he must have thought I had something to good to offer. I did have interactions with Dr. Lederman during my clinical rotations when he supervised me while I was seeing patients in the wards. I remember one time when we had a patient in the ICU, which he though was not being well-managed and he immediately demanded that the patient be transferred to another medical service. As a trainee who was just trying to finish up my patient list, I was wondering what the fuss was about. He took me aside and very seriously told me that if a doctor wasn’t willing to take the time to take care of a patient like that patient was his own father, then that doctor had no business taking care of anyone at all. This incident has strongly shaped the way I practice medicine. When I returned home, I ran headlong into a nascent HIV epidemic and the first person I called was him to tell him that, unfortunately, there was HIV back home. He flew to the Philippines on my invitation to help us out and again I found out later that he is very selective about the foreign trips he takes. With his guidance we were able to rally the medical community to make HIV a priority. During this visit to Cleveland, I told him about how we were able to make a difference in how HIV is treated in our country and that the current policies are very much at par with what richer countries are doing. I also told him about our successful pandemic response. He was quite pleased and he told me that he was very proud of me, and even if I technically wasn’t his academic offspring, he was gratified that he had somehow shaped me as a doctor. I countered that I was absolutely his academic offspring and more after all the life lessons I had learned at his feet. This happened a few days before Father’s Day and I could think of no better way of honoring our work together than writing about it for posterity. I wish everyone could be lucky enough to have a mentor as great as Dr. Lederman. A great mentor can shape your life for the better, and you can make lives better for other people.