‘Surgeons do not cry’

“My knife is my wife,” Dr. Jose “Ting” Tiongco told me 12 years ago. “My fascination with surgery has been total I have forgotten to get married.”

Ting is a brilliant surgeon, one of the passionate doctors who blazed a trail in health care cooperatives in Davao and later in the rest of the Philippines. Twelve years ago I did a feature-review (“Ting Tiongco and the dream”) of his book “Child of the Sun Returning”. On his book he had scribbled, “You once asked me if I was writing a book. I did. In my heart. Aniana.” Aniana is Visayan for “here it is.” A more dramatic translation would be “It is here.”

Earlier, I did a long cover story on him for the Sunday Inquirer Magazine. I went to Mindanao just for that. I got to watch him perform a Caesarian operation and interview his fellow doctor-visionaries. These doctors were once called “doctors who refuse to say die”.

Twelve years after “Child of the Sun Returning” I received from Ting another book titled “Surgeons Do Not Cry”, a compilation of his column pieces for a Mindanao news agency. On it he scrawled: “Twelve years later and the anger and bewilderment is still there. Thank God there is still hope!”



I was in Davao recently but I didn’t have the time to track Ting down. I hope he gets in touch. He must have a lot of stories crying out to be told. So Ting, let’s hear them, minus the wine.

If “Child of the Sun Returning” is the amazing story of the Medical Mission Group Hospitals and Health Services Cooperative Philippines (MMGHHSCP) as told by Ting who was one of its founders, “Surgeons Do Not Cry” (published by the UP Press) is about his earlier life, that is, as a medical student of the University of the Philippines College of Medicine (UPCM). The book was launched at UPCM yesterday.

It would be worth mentioning that before UPCM, Ting was a dyed-in-the-wool, true-blue Atenean from up the hill. And no wonder, UPCM presented itself as a new frontier, a wilderness to be conquered, and later, loved and be forever a part of his vision in life.

Published recently, the book is a fitting tribute to UP which is celebrating its 100th anniversary this year. It is also a good read for everyone, and most especially for aspiring doctors and health workers with blurred vision or whose sights are set on, ugh, serving on foreign shores. Ting’s idealism might just rub off on them. And Ting has a great writing style-wry, acerbic, cynical, raging, tongue-in-cheek. He does not write from the clouds. He writes from ground level.

Ting’s stories are neither pedantic nor platitudinous. They are everyday stories of a medical student, intern and resident at the UP-Philipine General Hospital. Here was a doctor-to-be on fire, so intense and so focused and yet having a great time. He was also in a hurry.

The reminiscences about those experiences of yesteryears were obviously written just recently or on hindsight, so one could sense the warmth and the fondness that come with distance and the passing of the years. One could also sense the confidence of a man who has poured out much.

Here is the story about the woman who yawned and locked her jaw (intern Ting had to “unlock” it twice); about Aling Bening, a patient’s mother who regularly stole food from the patients’ food cart “baka maubusan” (because there might be none left for her son); about blood donations or gota de sangre (a drop of blood) from medical interns; cheating at UPCM; “death on the table”—these could make a whole season of “E.R.” Philippine-version.

Instead of talking about what’s in the book, I might as well offer some excerpts.

From “Lanceta”: “A surgeon’s worst nightmare is to lose a patient on his operating table. So if and when this happens, it becomes a part of his life that is not to be forgotten forever—a DOT as we called it in UP-PGH. Death on the table.

“I had mine early. And to a certain extent, as my team captain would tell me later, I was spoiling for it…Arnulfo B. was in his late 40s, married and working as a welder during the daytime and as a part-time jeepney driver at night. At three in the morning, while he was plying the Malabon-Manila route, four men held him at knifepoint and demanded his money. He refused, thinking of his 10 children…So they stabbed him.

“There was a stunned silence in the OR as I closed Arnulfo B. as carefully as I usually closed all my operations. I wished aloud that God would not have to teach humility to doctors, especially surgeons, by using other people’s lives…Weary and red-eyed, I plodded out of the operating suites at five in the morning, just as the eastern sky was breaking into dawn. I desperately wanted to take a deep breath but I couldn’t do it without breaking into tears…

“Lani, my scrub nurse, had followed me out. And as she put her arm around the wife and began the ritual played outside so many operating rooms…I turned back to the operating suites and walked briskly away.

“Surgeons don’t cry.”

That’s where the title came from.

From “Stories”: “I packed all my baggage and collected my last experiences from UP-PGH on my last day of duty. I took a lone, last tour around the UP-PGH campus like a runner who, having run his last race, would take a ceremonial lap around the stadium….”

In the book is the voice of the boy who started out as “a screaming mess of contradictions and full of agonizing questions.” Ting dedicates the book to “a little girl, whose name rings bells in heaven.”

Ting, 61, once told me: “Becoming a doctor was the next best thing to priesthood. Total dedication. You give your whole mind, your soul.” Before taking that piece of cold steel in his gloved hand, he would whisper before the first incision: “Introibo ad altare dei…” (I will go unto the altar of God).

Do you have any questions?

A day at a factory

I invited myself to the factory. The company does not need media exposure or publicity. They don’t sell their products here. In fact the owner requested that there would be no mention of his name (let’s call him Mr. K), the company’s name, the brand names, etc. It was I who was interested to know more about what was going on in the factory, how production was, the workers, the size, the product. I had never been to something like this before.

I met Mr. K and his wife, through a friend, during the breath-stopping Cloud Gate Dance Theater performance at the Cultural Center of the Philippines some weeks ago. The show was part of the 50th anniversary celebration of the Ramon Magsaysay Award Foundation. The Cloud Gate’s founder Lin Hwai Min of Taiwan is an RM awardee (1999).

One day last week, I visited this Taiwanese-owned luggage factory (let’s call it the K company) just outside of Metro Manila. This factory produces some of the most expensive, if not some of the most durable luggage in the world, more expensive and more durable than the enduring popular brands that we know. That is what Mr. K, the Taiwanese owner, an electronics engineer, told me and he showed me why and how much the products cost abroad.



The K company produces 150,000 to 200,000 pieces of luggage every year. It has been operating in the Philippines for 13 years and employs some 700 workers. It used to employ 1,500 workers. All other luggage companies have left and moved to China (and are now not necessarily happy they did), except the K company.

The factory sits on 10,000 square meters of land. It is not inside an export processing zone. The production area occupies about 80 percent of the location and the rest is for offices, the cooperative-run canteen, the clinic, water purification (for drinking water which the workers could take home) and loading and unloading of goods. The huge production area is under one roof. If you are standing on the balcony of the second-floor office you would be overlooking the entire production area.

The place is spacious, clean, bright and airy. The ceiling is high. And from the balcony I could see hundreds of computerized machines and a sea of heads and hands at work.

Some 700 workers work on their machines or at their tables cutting, sewing, screwing, inspecting, assembling, labeling. The production and molding of the highly durable patented honeycomb plastic spine is custom-made in a separate section. The polycarbonate pellets (melted to make the honeycomb component) come from Singapore.

Most of the components are made-to-order and sourced abroad—the non-breakable patented zipper ear, the metal handles, the nylon thread as well as the fabric that is used inside and outside. The smooth leather for the really high-end items is from the Philippines.

Luggage of all sizes and dimensions adhere to airline requirements. The latest product is the checkpoint-friendly carry-on luggage that has a special section for a laptop. On it is attached a yellow label of approval which means the laptop need not be taken out for inspection because the X-ray machine could locate it easily and scan. The “TSA” label stands for travel security-authorization approved.

Zig-zag and double-stitching are some of the secrets of the luggage’s durability, Mr. K tells me, which you would see if you examine the product closely. Even the labels and tiny metal brand IDs are so well attached they are not going to get ripped and fall off during travel. Materiales fuertes, in other words. But you pay a fortune for these travel must-haves.

And then there are the imaginative practical details like the zips, secret compartments, instant expansion, easy grip and rolling. I thought to myself, you could travel to outer space with one of these. These products’ marketing catchword is “details make the bag”.

And why can’t we buy them here? Mr. K says everything they buy from abroad is duty free and this means all the products go abroad and aren’t meant to compete with local products.

And what about the workers? Some of the workers, like Jenny who is married and with two kids, have been with the factory for 10 or more years. Many came from other factories. There is no shortage of workers, Mr. K tells me. All these years the company has adhered to the law as regards wages, Mr. K says.

And why has he stayed? Mr. K says he wants to contribute something to this country. But he promptly adds that the Philippines must change many of its protectionist policies.

Taiwanese-owned factories have proliferated in China and Mr. K is not afraid to be quoted as saying that if Taiwanese companies would pull out of China, China’s industry would fall. The unofficial estimate of Taiwanese investment in China is about $100B, Mr. K says. Think of 100,000 factories employing 10 million Chinese.

Many Taiwanese investors are now choosing to go to Vietnam, India, Indonesia and the Chinese mainland’s interior, Mr. K points out. But not the Philippines.

I quote Mr. K verbatim: “The Philippines has to open up. Unions could be a problem. There are too many regulations. We cannot buy land and are subject to rent increases. We cannot go into retail.”

But, ah, the unions. Aren’t these the workers’ only protection? (I am a proud member of the Inquirer employees’ union.) In this age of globalization, unions are also starting to be globalized or join multinational trade unions. From the point of view of workers in the developing world this is an exciting development. More on this some other time.

Thanks, Mr. K, for the factory tour.

Knowledge economy 101

Seoul--When you give something a name, you empower it. And so, they’ve given it a name—knowledge economy or knowledge-based economy. In layman’s terms knowledge economy (KE) means using knowledge to create wealth. Wealth isn’t a bad word if it means quality life, not just for a few, but for all.

Representatives from six countries—Cambodia, Indonesia, Laos, Mongolia, Philippines and Vietnam—gathered in Seoul to learn more about knowledge economy and how it could be made to work in their respective countries. If you look at the list of countries that were invited, you would right away see that these are the economic laggards in Asia. In Pilipino, we say, the kulelat or in Ilonggo, kulihot.

The World Bank Institute and the Korean Institute of Development brought together individuals from these six countries, most of them educators from universities, government officials from the education bureaucracy, economic planners, information experts, plus a couple of media practitioners. Before we left for Seoul, we had to attend a teleconference and then go through some online learning about (KE) through—here’s a new word—moodling. Yes, in a classroom in cyberspace.

But nothing beats coming face to face with one another and with the gurus of KE who preach the gospel of KE. You bet, there was a lot of KE jargon flying around and a few times this journalist had to ask: What does that look like on the ground?

And what’s KE all about? Here are the ABCs I have lifted from notes.

Knowledge economy rests on four pillars: 1) improving the economic and institutional, 2) fostering innovation, 3) upgrading education, and 4) strengthening information and communication.

A sound economic and institutional regime (EIR) is of primary importance, we were told, for achieving better policy results in the functional knowledge pillars as well as for getting the most from related investments. Advanced economies have something to show for their success. They have well-established institutional frameworks based on democracy and free markets. But hand in hand with the development of a KE is an institutional framework that goes far beyond and into labor markets (employment flexibility, employability, mobility), sophisticated financial markets (microfinance, venture capital), products and services markets and effective protection of intellectual property.

What about the kulelats with mediocre economic and institutional regimes? They would require “a well-articulated, strategic set of steps focused on very specific problems and taking into account bureaucratic, political, social and economic interests.”

Innovation was a word that was mentioned so often. It is supposed to be the spearhead of the KE concept. Innovate or be left behind. Innovation is key to the developmental success of a number of countries, South Korea among them. Technological innovation, in particular, is crucial for dramatic growth, it enhances competitiveness and increases social well being.

Innovation can be defined as “the design, development and diffusion of something new to a given context, leading to a significant improvement in the economic, social or environmental conditions.”

Innovation occurs at three levels: 1) local improvements are made by adopting available technologies to satisfy basic needs or to upgrade products or services, 2) competitive industries to develop through adaptation of technologies initially produced in or by developed countries, 3) ultimately, new innovations of global significance are developed.

Innovation cannot be forced to happen. In developing countries an appropriate technical culture must first be built. Then there should be incentives to support and stimulate entrepreneurship.

And now the education pillar. Education is supposed to be the great leveler and enabler. It creates opportunities and reduces poverty. The educated individual is able to create, share, disseminate. An educated population, being more sophisticated, has higher demands, thus driving industries to innovate.

Strong information and communication technology (ICT) is the fourth pillar. It is the component that should fill the knowledge gaps in poor countries. ICT creates better efficiency and improves services. ICT creates advances in manufacturing, trade, governance, health care, agriculture and delivery of services. ICT also reduces costs, breaks down time and distance barriers and enables speedy mass production of goods.
Getting there, becoming a so-called knowledge economy does not happen overnight. Erecting the four pillars requires a long-term strategy. A country may be strong in one pillar but weak in another. Leaders and policy makers must be aware of the strengths and weaknesses of their people and resources.

For those interested, the World Bank Institute’s Knowledge for Development (K4D) has developed the Knowledge Assessment Methodology (KAM), an internet-based tool that provides a basic assessment of the KE readiness of a country or region. Log on to www.worldback.org/kam and find out.

KAM is meant to be a user-friendly interactive tool based on the KE framework. It was designed to help countries assess their strengths and weaknesses and compare themselves with their neighbors. KAM could help identify problems and opportunities for a given country, help direct its focus, say, in making policies and investments and how it could make a transition into a knowledge-based economy.

KAM is able to assess a country’s or a region’s comparative KE position on a global scale (compared with 140 countries), on a regional scale (compared with eight regional groupings), on the basic of human development and the basis of income levels.

KAM na.

Reflections for Ramadan

One of the 2008 Ramon Magsaysay Awardees I was able to interview recently was Ahmad Syafii Maarif of Indonesia. He is the awardee for the Peace and International Understanding Category.

The banner headline last Monday was was “Fighting continues as Ramadan begins.” Just below it was my article with the title “Terrorists hijack God, says RM awardee”. I thought it complimented the banner story.

Here was a revered Muslim scholar and activist, trying all his best to help restore the good name of Islam which has been tarnished by terrorists. “Terrorism is not the authentic face of Islam,” Maarif keeps stressing again and again. “The terrorists hijack God.”

These “hijackers” kill with the name of Allah on their lips, they invoke the name of Islam to justify their extreme causes. At this time when Islam is suffering a bad image because of the extreme behavior of some its adherents, a voice—brave and loud—calling for moderation is hard to find.



Maarif is a leader of the Muhammadiya, an Islamic reformist movement founded in 1912, and the founder of the Maarif Institute for Culture and Humanity which aims to project Islam as a religion that is inclusive, tolerant and respects plurality.

A respected intellectual and teacher, Maarif has written books and many articles on Islam where many could draw inspiration and guidance.

As there was not much space in last Monday’s article for excerpts from Maarif’s written works, I am sharing them here. In this holy month of Ramadan when Muslims fast, pray and purify themselves, it behooves the extremists to listen to the voice of reason.

Islam vs. terrorism: The brutal and inhuman actions committed by some Muslims through bombings and hijackings are no doubt the representative of their misbehavior and misconduct, and therefore have nothing to do with Islam. The public image, however, produced by their misbehavior has misled millions of people, whose knowledge of Islam is very shallow and limited. In other words, for these people, Islam is identical with terrorism, or, it is a religion of war and violence. By implication, to combat terrorism can mean to combat Islam. This accusation is extremely painful for the Muslims and those who understand Islam….

Islam and dialogue: Can Islam actively participate in civilizational dialogue? The answer is of course certainly affirmative. According to Islam, the very aim of the creation of mankind with different colors, tongues, racial and cultural backgrounds is that they may know one another, exchange experience, and live in peace. For this point the Qur’an has made it clear to us: “O men! Behold, we have created you out of a male and a female, and have made you into nations and tribes, so that you might come to know one another. Verily, the noblest of you in the sight of God is the one who is most deeply conscious of Him. Behold, God is all-knowing, all-aware.”

Islam and modernity: Unfortunately, since the rise of the Renaissance in 16th century Europe, religions have gradually but surely begun to lose their power and sensitivity to cope with the aggressive force of modernity. Christianity has, to a great extent, adapted itself, willingly or unwillingly, to the wave of this force. Other religions, Arab Islam in particular, has failed to come to terms with this modern development…(T)here are Muslims groups who have showed the attitude of total rejection to modernity and hidden themselves “in their past historical greatness, (and) the result is inevitable: a brooding anger and frustration.” Osama bin Laden’s phenomenon is the most recent instance of this, though the root of this is more complex and deep-rooted.

Islam and combating violence: What role should Islam as a revealed religion play…in combating violence which is now overwhelming some parts of the Arab world and other Muslim countries…? (T)he Muslims all over the world, in Arab countries in particular, should rethink honestly and seriously that Islam always means peace, in theory and in practice. Therefore, any violation of the doctrine of peace, by committing violence and terrorism, for instance, is no doubt a serious betrayal of the very teaching of Islam…

The truth: The mental attitude of monopolizing the truth, no doubt, constitutes one of the main causes of religious conflicts in history. Of course, each religion offers the absolute moral principles to humanity, but the interpretation of which can never reach the absolute position. The absoluteness and finality are not human’s but entirely God’s. In other words, those who claim to have reached the absolute truth and finality are perhaps not believers in its true sense but liars in the garb of revelation. This attitude is certainly very dangerous to the principles of peace and brotherhood. Being aware of this fact, the Qur’an, in two verses offers a reasonable solution to the primacy of cooperation between the followers of religious: “Compete in goodness.” Let’s then compete in goodness, not compete in accusing others of believing in false religions and worshipping a false God.

On religions: In a world split apart, the role of religions as sole transcendental anchor for humanity should have been decisive and more effective. Only religious can provide human beings the final answer of the meaning of life and death. Philosophers and scientists can only speculate about it without offering any certainty so far… Islam as the youngest religion after Judaism and Christianity shares many of the principles of moral imperatives of its older sisters and predecessors to offer a clear guide to mankind. This is not a surprise…because these three religions historically took their moral teachings from the same prophetic source, that is, from the Abrahamic spiritual office.