Odette and Ondoy

Philippine Daily Inquirer/Opinion/by Ma. Ceres P. Doyo

So many pieces have been written about Odette Alcantara and her life and times since her sudden passing on Sept. 22. She was going to turn 69 tomorrow.

I last saw Odette on Aug. 31 at the Ramon Magsaysay Awards at the Cultural Center of the Philippines. Although I attend the awards every year and write about the awardees, this year was special because our common friend, environmental lawyer Tony Oposa Jr., was one of the awardees. Odette was there, wearing her “10MM” dog tag which one got by signing a pledge to care for Mother Nature and which Tony conceptualized along with Odette and their fellow greenies.

Suddenly Odette was gone.

Yesterday my fellow women writers and I were supposed to go to Odette’s Blueridge home to celebrate her spirit but last weekend’s disaster-without-compare wrought by tropical storm Ondoy caused changes in our ability to go as a group.

I learned that Odette’s ashes will be scattered in her farm in Tanay, Rizal sometime soon. Tanay, one of the worst hit by Ondoy, and like so many places in Metro Manila and Rizal, is in ruins. Last Sept. 26 Ondoy brought a six-hour downpour that was equivalent to a month’s rain. The destruction was unprecedented. More than 200 lives lost and counting. It was extreme weather at its worst.

Ondoy missed Odette by four days. As I watched TV images of the roaring torrents, I imagined Odette’s spirit rising above the waters, warning, reminding. Ondoy is not the enemy. The enemy is us.

Odette and Ondoy. Two Os reminding mightily.

We, the Women Writers in Media Now (Women) celebrate Odette in a special way. It was at the old Heritage Art Gallery in Cubao, QC that our group often met during the dark days of martial rule. Heritage was a haven for activists, writers, artists, religious and other subversive types. Odette was always there, inspiring, comforting, hatching ideas, plotting moves, conspiring with kindred spirits.

After the place burned down, Odette did not fade away from our lives. She turned her Blueridge home which had a “recycled” ambiance similar to Heritage, into a new haven.

Planet Earth became Odette’s passion and soon her Blueridge home hummed with talk about trees, garbage, composting, recycling, segregating, reviving, invigorating. It wasn’t all talk. Odette walked her talk and moved many people to walk with her and dig their hands into the compost. She went out of her way and out of her comfort zone to teach, to inspire, to admonish, and most of all, to show why. She was Mother Earth personified.

Tall, lithe and almost always ruggedly attired, Odette cut an unthreatening, all embracing, welcoming figure. She had a penchant for outré puns and jokes. Everybody knew she was behind the “Los Enemigos” by-line that churned out funny but subversive tirades against the obnoxious enemies of the motherland and Mother Earth.

I have written a number of stories and column pieces on topics and issues that Odette had brought to my attention. She would call and talk non-stop about the latest object of her zeal until I realized that, yeah, that’s a good story. And then I’d be on my feet.

Odette often gathered the Who’s Who in the environmental advocacy and introduced them to her chosen few in media. There was always great home-cooked food, wine, art, classical and patriotic music to go with the conversation. And I often went home with a story to pursue and write.

She brought several of us to Vigan, Ilocos Sur to experience the historic place and relish its antiquity. Who else could have helped coin the catchy name KaiVigan (friends of Vigan), if not Odette? During that trip we laughed out loud at the jokes of artist Onib Olmedo and gasped at the torrid tales of writer and art enthusiast Lorna Montilla, both of whom passed on ahead of Lola O and just as suddenly.

Once Odette came to my house unannounced to see for herself my backyard edible garden and composting efforts then wrote about what I did in a magazine. She liked a column piece I wrote (“Someone is stealing my garbage”) and included it in a book of stories (“Doon Po sa Amin”) about persons who did their part for Mother Nature.

I did write a Sunday Inquirer Magazine cover story on Odette’s efforts to turn Blueridge green (“Green Becomes Blueridge”) and make it a showcase of recycling, composting and other pro-nature activities. Odette, with the help of her green-blooded neighbors and friends (Inday Berroya and Clean and Green’s Narda Camacho, among them), turned the barangay’s mini-garbage dump into a garden-sanctuary and ecology center.

Odette held seminar workshops for interested residents. Dealing with hard-headed residents of an upper-class village was no joke, she said. Touching on people’s lifestyles could touch off a neighborhood crisis. “But I’m a chess player,” Odette said to me, explaining how her chess background helped her plan her moves.

In no time, residents and their household help recited “papel, bote, lata plastik” (paper, bottles, cans, plastic) like a mantra and learned how to segregate their waste.

Odette’s green zeal reached beyond her Blueridge sanctuary. She traveled to remote places to teach and show how. She cooked up events not just on Earth Day but all throughout the year in order to bring Mother Nature’s message across. She played godmother to a number of organizations and movements that continue to thrive and strive to make Planet Earth a wondrous place. Only she could have thought of gathering 100 Ramons on the 100th birth anniversary of the much-loved Pres. Magsaysay and make them plant trees.

Something in me softly aches when I think of Odette as having left us for another realm. Adios, Lola O, beloved friend. I can imagine you laughing at the title of this piece. We have lost much this September of our lives, but we will rise again and continue.

PCIJ at 20

Philippine Daily Inquirer/Opinion/by Ma. Ceres P. Doyo

This week the Philippine Center for Investigative Journalism (PCIJ) is celebrating its 20th anniversary. How time flies. The past 20 years have indeed been colorful, dangerous years for this journalistic endeavour which is an Asian first and which continues to be not only investigative but innovative as well in its reporting and use of new forms of media technology.

Part of the celebration is a seminar for Asian journalists. The theme is “Peace, Human Rights, Good Governance: East Asian Democracies at the Crossroads.” Why this theme? In the next three years, PCIJ explains, a number of countries in Southeast Asia will witness strategic shifts in leadership through elections and parliamentary processes. General elections were recently held in Indonesia. The Philippines will hold its first national automated elections in May 2010. Parliamentary elections in Cambodia are scheduled to be held in July 2011. Thailand and Malaysia have recently witnessed changes in political leadership, while other nations in Southeast Asia continue their evolution into fuller, more stable democracies.

PCIJ hopes that the gathering would foster better understanding and engagement between and among independent and mainstream journalists, civil society groups, academe and development agencies about common concerns with protection and promotion of human rights, peace and good governance in both the restored and restricted democracies of Southeast Asia. It will provide learning sessions for journalists from Southeast Asia and in the process encourage cross-border reporting and correspondence on these concerns.

Events are unfolding in Asian countries even as these countries grapple with common concerns – how to keep the peace and settle pockets of internal conflict, how to institutionalize, protect and promote human rights, and how to sustain reforms and democratic processes and to uphold good governance. These critical issues rate high on the agenda not just of governments but also of journalists, civil society groups, academe, business and the professions. These concerns are unfolding amid dramatic changes in media and technology, and media consumption patterns across the region.

PCIJ thinks that the reformed and young democracies of Southeast Asia have done very little to foster interaction and engagement among their peoples. To PCIJ, this is a stark, if sad, evidence in the paucity of media reports with a regional perspective, as well as the nearly total absence of cross-border reports on common concerns like peace, human rights and democracy, done by teams of journalists from across national borders.

Since its founding, PCIJ has produced about 450 investigative reports and other stories in major Philippine publications, produced five full-length documentaries, and launched over two dozen books and video documentaries. PCIJ has won many major awards including nine National Book Awards, a Catholic Mass Media Award, and more than two dozen awards and citations from the Jaime V. Ongpin Awards for Investigative Journalism and a Ramon Magsaysay Award for one of its founders and executive director for many years, Sheila S. Coronel who now heads the Tony Stabile School of Investigative Journalism at Columbia University and who continues to serve in the PCIJ board.

Seasoned journalist Malou Mangahas, the present executive director, is pushing PCIJ to new heights and frontiers of investigative reporting. Other members of the board are David Celdran (chair), Howie Severino (vice chair), Dominick Danao, and me.

There are many individuals who were behind PCIJ’s growth and becoming. PCIJ was founded in 1989 by nine Filipino journalists who realized the need for newspapers and broadcast agencies to go beyond day-to-day reportage, that is, to go deeper and broader, show the bigger picture.

While the Philippine press is undoubtedly the liveliest and freest in Asia, deadline pressures, competition and budgetary constraints make it difficult for many journalists to delve into the causes and meanings of news events. PCIJ provides opportunities for journalists to go beyond their daily beats. This is not to say that the mainstream media are found wanting.

PCIJ does not intend to replace the work of individual news institutions but encourages the development of investigative journalism and to create a culture for it. PCIJ believes that the media play a crucial role in scrutinizing and strengthening democratic institutions, that the media could — and should — be a catalyst for social debate and consensus that would redound to the promotion of public welfare. The media must therefore provide citizens with the bases for arriving at informed opinions and decisions.

PCIJ is now a byword in Asian journalism. It is an independent, non-profit media agency that specializes in investigative reporting. The center funds investigative projects for both the print and broadcast media. It publishes books on current issues and an online investigative reporting magazine, i, on its official web site, www.pcij.org. PCIJ also publishes www.pcij.org/blog, a daily institutional news blog, and www.i-site.ph, a database and resource tool on Philippine politics and governance. PCIJ is also a training center for journalists. It offers seminars for news organizations in the Philippines and Southeast Asia. It also tackles issues involving the media and access to information.

PCIJ reports have prodded government action on issues like corruption, public accountability and environmental protection. Some have triggered the transfer or resignation of senior public officials and justices, and formed part of the evidence in the impeachment, and eventual trial for plunder, of a Philippine president.

Stem cells from me, for me

Philippine Daily Inquirer/Opinion/by Ma. Ceres P. Doyo

AVOIDING BEING MAUDLIN, I say, this is as straightforward as I can get:

Few people knew about what I went through from October 2007 to May 2008. During that time I was quietly battling a dreaded threat: cancer. I had lived a relatively happy, healthy lifestyle for many years. And then for some strange reason, I was going “lo-batt.” An enemy had struck. As I had disclosed earlier, I found myself next door to the pre-departure area. (See my four-part series on stem cell therapy, Inquirer, p.1, Sept. 14-17. This column piece is the side bar to today’s Part 4.)

God is the ultimate healer, one of my doctors reminded me. Yes, God worked through close family and friends, and in an amazing way, through persons of science, medicine and faith.

A novel therapeutic option, cellular therapy, was what I had in addition to the three standard therapies or the so-called “slice, poison and burn” procedures, to fight the dreaded C which was not in the earliest of stages.

But I continued to write my columns and a few features, and even went out of town for a story. My way of staying sane. I was never bedridden. But ask me another day about the dark night of the soul and I might tell you.

The plus was cellular therapy, a biological intervention (not pharmaceutical) which utilizes living cells to activate the body’s own immune system to fight cancer. It was not cheap (that’s all I can say). But, as they say, you can’t take your possessions with you. I console myself that in my own way I had participated in the advancement of molecular and regenerative medicine.

Survivor’s guilt notwithstanding, I continue to hope that cellular therapy would soon become affordable for many ailing people, the poor especially, of the developing world. (See today’s Part 4.) For it to be readily available, as in the case of other things cellular that used to be in the realm of science fiction. I say this in all seriousness. Cellular, remember the word.

In my case, stem cell therapy (Dr. Samuel D. Bernal) was the added boost to the radical procedures of surgery (Dr. Augusto Sarmiento), chemotherapy over several months (Dr. Marina Chua-Tan), followed by 30 days of radiotherapy (Dr. Enrico Tangco). For radiotherapy, or the “mopping-up operation,” I drove myself to the hospital every day for 30 days without fail for my 6 p.m. appointment no matter where I was coming from.

Everything was done at The Medical City. Its regenerative and molecular medicine laboratory is indeed something to marvel at.

Cellular therapy process begins with the subcutaneous (under the skin) injection of a granulyte-colony stimulating factor (G-CSF), about 12 to 24 hours before the harvesting of a particular type of white blood cells, the monocytes, from the peripheral blood. The procedure is called leukapheresis. The G-CSF stimulates the bone marrow to produce the granulytes and stem cells and stimulate the release of the cells into the blood.

Monday’s page 1 photo showed me hooked to the leukapheresis machine. This machine selectively collects the monocytes only while the other blood cells and liquid components are returned back to the patient. The procedure takes about four hours. In my case, leukapheresis was done two days after my surgery.

After they are collected, the monocytes are brought to the lab where they are grown using special media to convert them into dendritic cells. These cells are allowed to further mature using a mixture of growth factors and stimulating factors called cytokines. The mature dendritic cells are later fused with the tumor antigen from a tumor bank corresponding to the patient’s primary tumor. The tumor cells are irradiated before the fusion for safety reasons.

The fusion allows the mature dendritic cells to store the tumor membrane information in their memory. As a result, the dendritic cells acquire the ability to recognize and eliminate the tumor cells that they encounter in the body.

In my case, administration was done every three weeks through intradermal injection (two jumbo needles) on both arms. I would watch in wonderment the syringe deliver the light pink fluid containing a trained army. Oncologist Dr. Chua-Tan administered the stem cell injections six times over four months or one week before a scheduled chemotherapy session. She collaborated with Fil-Am Dr. Samuel D. Bernal, renowned stem cell wiz (physician, molecular biologist, lawyer, author and cancer survivor featured in Part 3 of the series.) A personal note: We called him Sammy when we were kids.

One good side effect was an increase in immune levels as shown in my blood chemistry, as well as great energy in fending off the aftereffects of chemotherapy. No nausea, no vomiting. I lost all my hair, of course (ask me about blisters caused by radiotherapy).

In the bigger battle plan that was dendritic cell immune therapy, the dendritic cells were programmed to recognize and zap the enemy cells to smithereens, keep them at bay, minus the collateral damage. Often, I would visualize it like an animation on screen. This was the gentlest procedure of all but by far the most magical.

I haven’t told half of my story, but I have to cut to the chase. In no time I was back on my feet and I hit the ground running, climbed hills, went out to sea, traveled far.

Last April, the portacath (through which chemo was administered), embedded under my skin on the collar bone, was finally removed. I had been wearing it like a badge for more than a year (though I could go swimming with it) long after the chemo had been over. It was no longer needed. I am keeping the thingamajig as a souvenir.

With stem cell therapy, I have indeed stepped into a new frontier, a brave new world of science and medicine.

Joy comes in the morning. All’s clear. I am very well. Ut in omnibus glorificetur Deus.

(PART 4) Stem Cells: Regenerative medicine--Hope or just hype

Read Part 1: Amazing healing power within our bodies 
(with side bar, "What are stem cells?")

Read Part 2: From science fiction to reality

Read Part 3: Lab nerd tweaks tiny particles to renew life

Human Face column: Stem cells from me, for me

 (Part 4-Conclusion)

Philippine Daily Inquirer/Special Report/by Ma. Ceres P. Doyo

IS THIS THE HOLY GRAIL of medicine in the 21st century? Is this new emerging field going to provide dramatic changes in the way diseases and injuries are studied and treated?

Stem cells and regenerative medicine are the new catch words in health care. Scientists have discovered the stem cells’ amazing characteristics and therapeutic potential.

But stem cell therapy in the Philippines is not without its skeptics for a variety of reasons. It could be a threat to drug-dependent therapy.

Doctors will have to get out of their comfort zones to learn new ways. It is still very expensive and labor intensive.

Dr. Alfredo Bengzon, president of The Medical City (TMC), is undaunted. He has flung the hospital’s doors open to the technology and eagerly awaits a new breed of Filipino scientists who will carry it through.

Leading Philippine universities are preparing scientists and doctors for this endeavor.

With Dr. Samuel D. Bernal leading the team, TMC recently acquired more high-tech laboratory machines to boost its regenerative medicine section of which stem cell therapy is one component. TMC’s “regen” department was introduced to the public on Aug. 19.

Convergence of disciplines

“Regenerative medicine is a convergence of disciplines—cell biology, electrophysiology, molecular biology, biochemistry,” Bernal explains.

“It is difficult to carry out, it involves a major investment for an institution and requires a culture that is committed to providing a customized, personalized approach. This is the advantage of TMC,” he said.

Regenerative medicine, which includes stem cell therapy, is defined as innovative medical therapies that involve the engineering of living cells, tissues and organs for the purpose of preserving and enhancing organ function.

It is meant to prevent disease and maintain wellness as well as to restore or replace organ function that has been lost or impaired due to disease, injury or aging and with the purpose of improving the quality of life.

Is this field meant for a special few who have the financial means? A study by experts shows that regenerative medicine can greatly benefit poor developing countries with huge unhealthy populations. But governments and institutions would have to invest in the technology.

Bioethical questions

Bioethical questions must be clarified. Only the use of human embryos as a source of stem cells is being questioned on moral grounds. Pope Benedict XVI, in his first meeting with US President Barack Obama in Rome last July, stressed opposition to abortion and stem cell research using human embryos which the Catholic Church considers to be human life.

And why is stem cell therapy very expensive? “Mabusisi (labor intensive),” Bernal quips.

The equipment, reagents and materials needed for this technology are costly and are imported. Personnel are not easy to come by and have to be trained. But in the future, when more people opt for the therapy, costs could be dramatically reduced.

10 promising applications

A couple of years ago an international panel of 44 experts embarked on a study to identify the 10 most promising applications of regenerative medicine in developing countries. The majority were from developing countries.

Among the areas identified for the application were: (1) insulin replacement and pancreatic islet cell regeneration for diabetes, (2) autologous cells (from the patient) for the regeneration of heart muscle after myocardial infarction and cardiomyopathies, (3) immune system enhancement by engineered immune cells and novel vaccination for infectious disease.

The study also showed that regenerative medicine could potentially be used to improve health conditions in poor countries. For this purpose local efforts in health biotechnology are ongoing in countries like India, China (with huge government funding) and the Philippines.

Government support

In the Philippines, government support has not been huge but the Department of Health and the Department of Tourism are promoting efforts in this area. National Kidney and Transplant Institute and Lung Center of the Philippines (LCP) have acquired expensive state-of-the-art equipment for stem cell therapy and research.

LCP’s bio-regenerative program began in the 1990s but it was shelved after the center was razed by a fire in 1998. Dr. Juanito A. Rubio, LCP director, revived the program.

LCP is the first and only government hospital in the Philippines that does intensive study of the treatment of lung diseases and multi-drug resistant TB through its bio-regenerative program.

LCP is now inviting cancer patients to volunteer for clinical trials.

Heading LCP’s bio-regenerative team is Dr. Ma. Teresa Barzaga. Also in the team is Dr. Francisco Chung Jr., doctor of pathology and molecular medicine. Pulmonologist Dr. Sullian S. Naval heads research and development.

Medical tourism

Tourism Undersecretary Cynthia Carreon and Director Cynthia Lazo are working hard “to get the word out” that the Philippines is very much in the health and wellness revolution.

Regenerative medicine is in the list of health services the Philippines could offer. A good number of health institutions have international accreditation.

Medical tourism had its bad days especially when underground organ trafficking in developing countries was exposed.

But stem cells in regenerative medicine is exposing the amazing potential and expertise in countries like the Philippines. Soon it will no longer be for a select few who have the access and the wherewithal, but for the many.

There all the time

Are stem cells hope or hype? Has the Holy Grail been found? The quest for new cures will never be over, but one discovery always leads to another. In the case of stem cells, they were right in there all the time, inside each one of us, from the moment we became life.

(Editor’s Note: The writer’s account of her dendritic stem cell therapy is in her Human Face column Thursday, Sept. 17, 2009. Feedback to cerespd@gmail.com)

(PART 3)Stem Cells: Lab nerd tweaks tiny particles to renew life

Read Part 1: Amazing healing power within our bodies
Read side bar to Part 1

Read Part 2: From science fiction to reality
Read Part 4: Regenerative medicine: hope or just hype
Read Human Face column: Stem cells from me, for me

(Third of a series)

Philippine Daily Inquirer/Special Report/by Ma. Ceres P. Doyo

MANILA, Philippines—Physician, lawyer, chemist, molecular biologist, Ph.D. and MBA holder, professor of medicine, cancer director in US hospitals, leading figure in stem cell research, cancer therapy and bioregenerative medicine. Cancer survivor.

“Before I became a medical doctor,” says Dr. Samuel D. Bernal, “I was a hard-core chemist.” As a lab nerd, he poked, coaxed and tweaked the smallest particles of life. He then segued into medicine. His specialization: Stem cells in regenerative medicine and oncology, or the treatment of cancer. But he never really left behind the amazing world of molecules.

This Filipino-American doctor is a moving force in the regenerative medicine department of The Medical City (TMC) where he holds clinic when he’s not abroad.

Whether health practitioners and medical schools realize it or not, molecular is the way to go in the brave new world of medicine. In the smallest and basic particles of the human body—the cells—are contained a wealth of information and potent forces that could open doors to new ways of treating ailments.

Bernal, 59, brings to his medical practice an approach that is personalized and customized down to the molecular level. This means debunking the one-size-fits all standard-of-care approach that puts patients in neat categories or assembly lines.

Impersonal care

“When I ask how a patient is and an intern just gives figures, I become red. I want to know how is the patient faring emotionally, spiritually? Is he comfortable, happy, sad, in pain?” Bernal says.

He rues the way patient care has become impersonal.

This is what moved him to file on behalf of a Filipino-American family, a landmark malpractice suit against a group of doctors, a hospital and a health insurance group in the United States that he accused of hiding behind so-called standard of care procedures. The respondents settled out of court for an unprecedented sum.

Born in Iloilo, Bernal went abroad after his father became a US consultant.

The third of four siblings, Bernal finished chemistry at the University of Illinois in 1969. He already had a doctorate in biochemical pathology when he took up medicine at the University of Chicago.

In 1979 he was a fellow in internal medicine at Harvard Medical School and, later, in medicine at the Peter Brent Brigham Hospital in Boston. He trained in oncology at the Dana-Farber Cancer Institute at Harvard.

Multidimensional person

Bernal is a board-certified oncologist and is a diplomate of the American Board of Cancer Specialists. He has authored papers and books on cancer.

Bernal earned his Doctorate in Jurisprudence from Loyola University and is a licensed attorney. He also has an MBA degree from the Pepperdine University on biotechnology business strategies.

Since 1992, Bernal has been with the University of California in Los Angeles where he is professor of medicine. He is connected with several hospitals and biotechnology institutions and still finds time to teach at the Ateneo School of Medicine.

A multidimensional person, he is also into theater and literature.

Cancer strikes

In 2000, Bernal was stricken with cancer.

“I had no clue, I was completely healthy, writing a book,” he remembers. “I was doing the chapter on kidney cancer.” He noticed a change in the color in his urine and looked at a sample in the microscope. He could not believe what he saw.

Examinations later showed the cancer had invaded his abdomen, left kidney, liver and lung.

“You could be dying and you don’t know it. My head was floating, my mind went numb. It was a totally surreal experience. I was given a pronouncement of death, three to four months,” he says.

“I was on top of my profession and in control. Suddenly I was vulnerable. It was a setback. I had several papers and two more books in progress. I kept telling myself that my work was not finished.”

Customized treatment

Bernal consulted colleagues all over the world. He was advised to enter into a protocol. “I had to customize my own treatment,” Bernal says.

He went for abdominal and thoracic surgery even if it meant working around a major blood vessel to scrape and carve out the damaged parts.

“I was in the ICU for three weeks because my lungs would not re-expand,” he said.

“During the operation they got live cancer cells that were then cultured so we could observe their behavior and response to treatment. This is not ordinarily done,” he says.

Bernal’s cancer was the type that will not respond to radiotherapy or chemotherapy. The treatment he drew up for himself was admittedly expensive and difficult.

“A lot of it was based on molecular biology work of scientists and this knowledge was not available to clinicians,” he says.

Bernal devised his own dendritic immune therapy, using his own stem cells.

“The experts around the world encouraged me to do it myself. But at that time, they wouldn’t recommend it to their own hospitals. They said it was difficult, impractical and expensive. It was being done but on an experimental basis,” he says.

Intimations of mortality

“I prepared myself to face my mortality. I fixed my finances and properties. I was already divorced then,” Bernal says.

He lost 40 pounds. But after six months things began to clear up. After more than a year, Bernal was back on his feet.

No wonder Bernal is passionate about customized medicine and is on a personal mission to promote it. “The one-size-fits all protocol for serious diseases does not work. But 99 percent of cancer specialists cannot do it if their hospitals cannot do it,” he says.

Stem cell therapy, Bernal points out, is only one of the components of regenerative medicine. And because cells are not drugs that are mass-produced, they are not for food-and-drug approval.

He shares a 2006 study that shows the significant impact stem cell technology could have on poor, developing countries in addressing their health concerns.

“Even if 99.99 percent of doctors here would say it is inappropriate, here are these world experts saying otherwise,” he says. “The most powerful force for healing our body is in our own body.” (To be continued)

(PART 2) Stem Cells: From science fiction to reality

Read Part 1: Amazing healing power within our bodies
Read side bar to Part 1: What are stem cells?
Read Part 3: Lab nerd tweaks tiny particles to renew life
Read Part 4: Regenerative medicine: hope or just hype
Read Human Face column: Stem cells from me, for me


(Second of a series)
Philippine Daily Inquirer/Special Report/by Ma. Ceres P. Doyo

IN THE PHILIPPINES, a name that has become synonymous with stem cells, and in a bigger dimension, with molecular and regenerative medicine, is Dr. Samuel D. Bernal. 

“Molecular medicine,” Bernal proclaims, “is now, the present. Not the future. In this era of molecular biology, we are now recognizing even more that personalized medicine involves analyzing the molecular characteristics of a patient.”

The Filipino-American doctor is a cancer survivor who applied on himself his knowledge of regenerative medicine and stem cell therapy when he was thought to be dying nine years ago. He stresses that the body holds a potent army for healing that needs to be harnessed and trained to recognize the enemy.

Bernal holds clinics at The Medical City (TMC) in Pasig City when he is not treating patients in Los Angeles or Prague. (More on Bernal tomorrow)

“We constantly gather objective data so that we have a basis to follow scientifically what is happening to the patients’ bodies and their cells,” Bernal emphasizes. “We recognize the uniqueness of individuals at the molecular level.”

He cites the case of a 38-year-old patient from Las Vegas who was “essentially dying.”

Oncologist Dr. Marina Chua-Tan says of the case: “He had cancer in the lungs, spleen, brain, spine. He had already stayed at a hospice and was expected to die in a few months. His father checked us out and brought him to TMC. On his fourth stem cell injection the CTscan imaging showed that his tumor had receded, then the spinal fluid became clear of cancer cells. He is alive, functional, jogging. He even got married.”

“We are not saying that he is completely cured,” Bernal adds, “but his quality of life dramatically improved. Prolongation of life—that is a major achievement. There are patients that doctors have given up on. Four years ago we had this doctor who had cancer all over her body. Now she is free of the disease.”

Dendritic

Another patient at TMC, Androclus Ranises, 69, has been receiving dendritic cell therapy using his own adult stem cells. Autologous, it is called, or reimplanting cells that have gone through a laboratory process. The businessman from Cagayan de Oro City was diagnosed in 2007 as having Stage 3-4 multiple myeloma or cancer of the bone marrow.

He now raises his arms to show how increasingly strong he has become and how the disease has been kept at bay. “I hope to live beyond 80,” he exclaims.

Interior designer Marisa Oreta, 53, was diagnosed in 2006 as having stage 4 colon cancer. In the Philippines, she underwent resectioning of the colon and in Singapore she went through peritonectomy, a high-risk surgery to clean out her affected peritoneum. She had chemotherapy, six stem cell injections plus three boosters at TMC. So far, she’s been holding up well, enjoying life and traveling every now and then.

Former Labor Secretary Nieves Confesor, now associate dean at Asian Institute of Management, was discovered in 2006 to have Stage 1 leiomyosarcoma, a rare form of cancer in her uterus. “It took five months for doctors to discover what was wrong,” Confesor says. “I had lost 45 pounds and I had fevers of unknown origin.”

Confesor had surgery and six cycles of chemotherapy but in 2007, nodes were discovered in her left lung and she again had to go under the knife. Before that she had thyroidectomy. She decided to have stem cell therapy.

“It has really helped me,” Confesor says. “It’s been three years.” She continues to teach and to participate in peace negotiations involving groups in conflict.

Innovative

More than 100 patients had either undergone or are undergoing stem cell therapy at TMC. The procedure does not come cheap and because it is classified as “innovative,” it is not covered by insurance. But it is hoped that in the future, just like all breakthroughs in technologies, it will be within the reach of many.

At St. Luke’s Medical Center (SLMC) in Quezon City, scientists and doctors broke new ground in 2006 with the use of stem cells in treating patients that have been blinded or partially blinded because of surface damage.

Dr. Jessica Abano headed the transplant which successfully resurfaced the left eye of a 52-year-old man who had been blinded by a chemical burn years before and could not be effectively treated with conventional surgery. It was the first limbal stem cell transplant in the country.

Abano describes the procedure while showing an actual video: “A small biopsy (1mm x 2mm) of stem cells was harvested from the healthy conjunctiva of the patient’s right eye in a painless procedure that lasted less than 10 minutes. The biopsy was then brought to the hospital’s Research and Biotechnology Division.”

Using a piece of amniotic membrane (the wrapping of newborns) as medium, scientists coaxed the cells to grow over two weeks into a film of tissue about 25mm x 25mm. After the abnormal fibrovascular growth was removed from the patient’s damaged eye, Abano stitched the bioengineered epithelial sheet on the eye.

Bioengineered tissues

Says Dr. Mark Pierre Dimaymay: “With ocular stem cells, we demonstrate our ability to perform cutting edge basic laboratory research with direct clinical applications.” Set up in 2004, St. Luke’s stem cell lab is the first in the Philippines.

This is an important step toward the stage when tissue engineers may be able to produce readily cornea replacements that can be easily transplanted whole into patients with severe cornea damage, says Dimaymay. “Today we can do ocular surface tissue. In the future we could learn to do the retina. The technology to replace diseased cells in various organs with bioengineered tissues is rapidly moving from the realm of science fiction to reality.”

This breakthrough is significant in the Philippines where eye surface injuries are more common than in more developed countries.

SLMC is now pursuing a study using stem cells from the buccal mucosa (inner part of the cheek) to treat patients with injury on both eyes.

Lab monkeys

Since 1997, SLMC, the University of Medicine and Dentistry of New Jersey and the Simian Conservation and Breeding Center have been working together to develop a protocol to induce myocardial infarction (heart muscle damage) in monkeys. Stem cell technology is then used to treat the damaged heart.

Dr. Filipina Natividad explains that the monkeys (macaques) in the SLMC lab are the source of the stem cells and are also the recipients of the stem cell transplants. This is an autologous cell transplantation where the monkey patient is both the donor and the recipient.

Before damaging the monkey’s heart, scientists harvest stem cells from its bone marrow. These are then cultured in the lab and made to grow as heart muscle cells. Experiments are still ongoing. It will still be a while before this could be replicated on humans here in the Philippines.

Dr. Joven R. Cuanang, SLMC senior vice president and chief medical officer, discloses that SLMC has also performed stem cell therapy on someone with spinal cord injury. The stem cells were taken from the patient’s bone marrow and injected near the injury.

“We had to go through an ethical review of its value and risks,” Cuanang says. The stem cells were processed with the help of a Singapore partner. (To be continued)

(PART 1) Stem Cells: Amazing healing power within our bodies

Read side bar: What are stem cells?
Read Part 2: From science fiction to reality
Read Part 3: Lab nerd tweaks tiny particles to renew life
Read Part 4: Regenerative medicine--hope or just hype
Read Human Face column: Stem cells from me, for me

(First of a series)

Philippine Daily Inquirer/Special Report/by Ma. Ceres P. Doyo

MANILA, Philippines—Who’s afraid of stem cell therapy?

Not me. I went through it—with the use of my very own adult stem cells. It was part of the therapeutic package—radical, immediate and customized—meant to battle a life-threatening health condition that I faced in late 2007. I was next door, so to speak, to the pre-departure area.

I underwent surgery, chemotherapy, radiotherapy—the so-called “slice, poison and burn” procedures—plus stem cell therapy, which was the most customized and personalized and the least invasive.

My doctors and I believe stem cells had helped significantly not just to reduce the impact of the three radical procedures, but, more importantly, they played their own independent role in targeting the enemy without collateral damage. They helped restore my health and made me hit the ground running again, go out to sea, climb hills, travel far. From “on the verge” to “very clean.”

 

God is the ultimate healer, but doctors say that within each one of us are amazing microscopic molecular components called stem cells that could help reverse, regenerate and restore what had been diseased, damaged or destroyed. They were in our body when we were born.

Stem cell therapy and research have been in place in the Philippines for many years. Abroad, particularly in the United States , bioethical questions have been raised regarding the use of one of its sources—human embryos. Not in the Philippines , where human embryos and aborted fetuses are not being used by hospitals that are into stem cells.

An important reason is that there are other safe, acceptable and effective sources. One is a patient’s own body cells and tissues (blood and skin, among them). The other is blood and stem cells from umbilical cords—those amazing lifelines in the womb that come with newborns.

In step with the world

Some Filipino proponents of stem cell therapy and research say that the Philippines is in step with, if not a step ahead of its neighbors and countries that are more economically advanced.

Two premier private hospitals—The Medical City (TMC) and St. Luke’s Medical Center (SLMC)—and two government institutions—National Kidney and Transplant Institute (NKTI) and Lung Center of the Philippines (LCP)—are now pushing stem cell technology into the mainstream.

Although the Philippines is faced with enormous health and nutrition woes because of poverty, advocates of the procedure say this does not mean that advances in science and technology have to be put on hold until all the primary health care concerns have been addressed.

Dr. Alfredo Bengzon, a former health secretary and TMC president, says: “This is our contribution to our country. We considered this when we decided to invest in this technology. This is also about patriotism. We will have to stand up to the rest of the world.”

Obama and embryos

Other Asian countries openly doing both stem therapy and research are China , Japan , South Korea and India . Singapore and Taiwan are into research while therapy is still in the experimental stage.

Supporters of this medical endeavor agree that the Philippines cannot be left behind because this country has the technology, the expertise, the manpower and the culture of care-giving. Tertiary hospitals here have girded up for the burgeoning of medical tourism.

US President Barack Obama’s lifting of the ban on embryonic stem cell research has rekindled fears that this could open a Pandora’s box and the cloning of humans. There has been renewed interest in US media on stem cells and how they could help battle diabetes, heart disease, Parkinson’s and other conditions.

But an expert says that some stories created more confusion rather than better understanding of the safety and bioethical issues.

The bioethical problem has to do with the use of stem cells from human embryos (embryonic stem cells) and deliberately aborted fetuses as well as the use of genetically modified stem cells (induced pluripotent stems cells or iPS cells). There are bioethical and biosafety issues regarding iPS cells because of immune rejection and risk of developing cancer.

Cells could now be reprogrammed to become cells in an embryo-like state without ever using embryos (fertilized eggs that are considered to be life in the making). This was first done in Japan and, through a different process, in the United States . These stem cells could then produce daughter cells that can potentially become any specialized cell to repair/replace diseased or damaged body parts (heart, bone, muscle, brain). With iPS, the moral debate over embryonic stem cells could be rendered moot.

But, and there is a big but, these so-called iPS cells have not been sufficiently tried and tested and could pose dangers.

On the other hand, the use of the umbilical cord (blood and stem cells) of newborn babies and the patient’s own (adult stem cells) do not pose a bioethical dilemma as no human embryos are being tampered with. Theologians and bioethicists are clear on this. Moreover, adult and umbilical stem cells have established records of safety and efficacy.

Stem cells for health

At TMC, cancer patients could avail themselves of dendritic stem cell therapy as an immune-system-boosting procedure. TMC also offers stem cell therapy for heart ailments and spine injury. For about five years now, more than 100 patients have received stem cell therapy at the hospital.

At SLMC, stem cells are being used to repair injured eyes—for free for volunteer patients. Its nearly 100 percent success in this procedure could make it become mainstream and available to many—but at a cost.

Stem cell research involving monkeys is also one of SLMC’s promising ongoing scientific projects that could offer breakthroughs.

Stem cell banking (from umbilical cords) is offered in both TMC and SLMC. There are biotech companies that now offer the technology, but a doctor of molecular biology warns those who use the name stem cells in vain and who are out for profit.

NKTI and LCP have acquired high-tech machines that are a dream-come-true for Filipino molecular biologists. Lung cancer and TB patients, being among the main concerns of LCP, could benefit from procedures using stem cells.

Major proponents of stem cell therapy in the Philippines look forward to partnership and sharing of facilities that would reduce cost and benefit patients.

How far have Philippine efforts gone in the brave new world of stem cells? (To be continued)

What are stem cells? (Side bar to Part 1)

STEM CELLS ARE the primary cells in the human body from which all other tissues “stem” from. They could be programmed in the laboratory to potentially become any other kind of cell and could be used to repair damaged tissues and replace diseased organs.

Stem cells are found in most, if not all, multicellular organisms and are characterized by their ability to renew themselves into a diverse range of specialized cell types. The field developed from the findings of Canadian scientists Ernest A. McCulloch and James E. Till in the 1960s.

There are two broad types of mammalian stem cells: Embryonic stem cells that are isolated from the inner cell mass of blastocysts, and adult stem cells that are found in adult tissues.

In a developing embryo, stem cells can differentiate into all of the specialized embryonic tissues. In adult organisms, stem cells and progenitor cells act as a repair system for the body, replenishing specialized cells, but also maintain the normal turnover of regenerative organs, such as blood, skin or intestinal tissues.

Stem cells can now be grown and differentiated into specialized cells, among them, heart muscles, nerve cells and blood cells. Stem cells from the bonemarrow, umbilical cord blood and highly plastic adult stem cells from a variety of sources are now routinely used in a variety of medical therapies. This holds a lot of promise in treating a variety of conditions in the future, among them, Parkinson’s disease, diabetes, spinal injuries, heart disease, vision and hearing loss.

Stem cells from blood is harvested with the use of a machine to which a person is intravenously connected. White blood cells (WBC) are collected while the rest of the blood components are returned to the body. In the lab, the WBC go into a special growth broth that could be used to kill cancerous cells.

Source: National Institutes of Health resource for stem cell research

Stop poison rain, foreign experts ask PGMA

Two hundred signatories from 44 countries, among them, noted scientists and health experts, have asked Pres. Gloria Macapagal Arroyo “to end poison rain” or the aerial pesticide spraying of banana plantations in Mindanao.

“We are writing to register our support for the ongoing effort of rural poor communities in Mindanao, Philippines to stop the aerial spraying of agrochemicals in banana plantations,” the signatories said.

“In the spirit of global citizenship,” they added, “we state our solidarity with the women and men of the Mamamayan Ayaw sa Aerial Spraying (Citizens Against Aerial Spraying) and many other people’s organizations from the various banana-growing provinces in southern Philippines who are asserting their inherent right not to be harmed by aerial pesticide operations.”



Calling aerial spraying “a clear and present assault against individual and collective rights” the signatories denounced the chemical exposure of farming communities in the vicinity of banana plantations where aerial spraying is used. “We support them in their just quest to keep harmful chemicals away from their bodies, homes and farms,” the signatories said.

Among the signatories are Dr. Paul Connett, Professor of Chemistry, USA; Yuyun Ismawati, 2009 Goldman Environmental Prize Winner, Indonesia; Jayakumar Chelaton, zero waste and endosulfan ban crusader, India; Sarojeni Rengam, pesticide activist Malaysia; Dr. Paul Saoke, anti-DDT public health expert, Kenya; Rico Euripidou, environmental epidemiologist, South Africa; and Fatou Hann, Women of Africa Guinea.

The group commended Health Secretary Francisco Duque III and the Executive Committee of the Department of Health (DOH) “for standing by and adopting the key recommendations arising from a study prepared for the DOH, the Philippine Society of Clinical and Occupational Toxicology and the University of the Philippines - National Poison Management and Control Center.”

The recommendations were:
1. Establish a health surveillance system to detect effects of chronic pesticide exposures.

2. Perform systematic and periodic monitoring of pesticide residues and metabolites in the environment and do remediation where necessary

3. Develop and strengthen guidelines for protecting communities from pesticide contamination from plantations.

4. Stop the aerial spraying of pesticides in the light of the precautionary principle espoused by the Rio Declaration of which the Philippines is a signatory.

5. Shift to organic farming techniques to prevent harm to health and the environment that can result from acute and chronic pesticide exposures.

In their letter to Pres. Arroyo, the signatories said, “Now that the country’s number one public health agency has spoken, we respectfully urge you to issue without delay an Executive Order banning the agricultural practice of aerial spraying that will reflect and strengthen the position of the DOH Executive Committee.”

Such a policy based on prevention and precaution, the group said, will surely contribute to the national implementation of the Strategic Approach to International Chemicals Management (SAICM) that aims to minimize and eliminate the harms caused by exposure to toxic substances.

They also urged the President “to use the power of your office to direct the banana industry to honor their corporate social responsibility and cooperate towards achieving the recommendations set out by the DOH in the greater interest of public health.”

School children on their way to school, farmers cultivating their small farms, people drinking coffee al fresco and families doing their daily chores are among those who suffer indirect hits and have to run for cover when airplanes unleash pesticides on vast banana plantations. While they are not the intended targets, there is no way they can avoid getting hit by the airplanes’ toxic load. Respiratory and skin ailments are among the first signs of a toxic hit.

Farm animals, edible plants and water sources also catch their share of the toxic rain.

Aerial spraying is not the only way to fight pests, MAAS has stressed again and again. There are other ways, among them manual and boom spraying, but banana plantation owners prefer the aerial method in order to cut costs.

Davao City is not the only place in Mindanao that has to put up with aerial spraying. Davao City’s feisty mayor Rodrigo Duterte is a vocal anti-aerial spraying advocate and the local government had passed an ordinance against it. But the Philippine Banana Growers and Exporters Association (PBGEA) challenged the ordinance in court.

The petitioners got a favorable decision but PBGEA elevated the case to the Court of Appeals. Meanwhile, aerial spraying continues.

According to MAAS, aerial spraying is a way of applying pesticides on agricultural crops with the use of airplanes. In the Philippines, exporters of Cavendish bananas use this method to kill the Sigatoka fungus. Filipinos prefer to eat the native varieties.

Aerial spraying hits not just the intended targets but human and non-humans as well that happen to be within the range of the toxic fallout. MAAS said that the toxic drift reaches 3.2 kms. on the average.

The provincial government of Bukidnon banned aerial spraying way back in 2001 and North Cotabao in 2004. Davao City’s 2007 ordinance to ban aerial spraying is being challenged by plantation owners because it supposedly violates their right to property.

Sen. Miguel Zubiri and Rep. Rufus Rodriguez have filed bills to ban aerial spraying in the entire country.

RM Awardee Antonio Oposa Jr: RP lawyer uses law to protect Mother Nature

Phiilippine Daily Inquirer/Feature
IF HUMANS IN NEAR-DEATH situations need CPR (cardiopulmonary resuscitation), ailing Mother Nature also needs CPR (conservation, protection and restoration/rehabilitation).

That’s according to environmental lawyer Antonio Oposa Jr., who uses medical jargon to call attention to the alarming state of the Philippine environment. But more importantly, he uses the law to protect LAW (land, air and water).

The play on words and meanings is vintage Oposa, one of this year’s six recipients of the Ramon Magsaysay Award who were honored on Aug. 31 by the Ramon Magsaysay Award Foundation for their various contributions to society and for embodying that special RM factor—“greatness of spirit.”

The foundation hailed Oposa, 54, “for his pathbreaking and passionate crusade to engage Filipinos in acts of enlightened citizenship that maximize the power of law to protect and nurture the environment for themselves, their children and generations still to come.”

When this year’s awardees were announced, Oposa’s name was in the headlines—the result of a landmark case he filed more than 10 years ago with the Supreme Court on behalf of the polluted Manila Bay and future generations.

In December 2008, the high court upheld Oposa’s case and compelled the named government agencies and local governments to regularly report to the court their efforts and their results.

Alas, six months later, almost all the respondents failed to show proof of their efforts. The Supreme Court was not pleased.

Oposa raised the alarm once more to call attention to the blatant neglect, apathy and disobedience.

Environmental security

Coinciding with the Ramon Magsaysay Award rites at the Cultural Center of the Philippines was the launch of the Ten Million Movement, which Oposa and his fellow advocates initiated to urge Filipinos to sign up and commit to “environmental security.”

Signatories received dog tags embossed with “10MM” and a what-to-do list. Oposa said the signatures would be presented to political parties and candidates on Earth Day 2010.

“Environmental security is the highest form of security,” Oposa thundered while delivering his acceptance speech at the awarding ceremony. His miting de avance-type remarks at the formal occasion drew loud applause from a stunned and delighted audience.

In his speech, Oposa cited the efforts of Elpidio de la Victoria, his close friend and partner in the Visayan Sea advocacy, who was shot dead in 2006.

He said the award also belonged to the Supreme Court, “for reminding humankind that we are only the trustees of the land, the air, and the waters for the benefit of generations yet to come.”

Quoting David Brower who coined “CPR,” Oposa said: “We cannot have peace unless we have peace with the earth.”

Oposa has led daring operations against environmental crime syndicates.

In 2004, he led a raid by agents of the National Bureau of Investigation, Philippine Navy, Philippine Maritime Police and Bantay Dagat. They seized one ton of blasting powder and sent the culprits to jail.

He led the same team to serve warrants of arrest on owners of big commercial fishing fleets who were once untouchable.

Later that year, he led a special police team in a raid that resulted in the largest seizure ever of blasting powder and detonating devices and the arrest of the syndicate leaders.

Numerous awards

The Ramon Magsaysay Award is not Oposa’s first. In May, he received the Environmental Law Award (for 2008) from the Washington-based Center for International Environmental Law—the first Asian to be thus honored.

For his work in advancing environmental law enforcement, he was chosen one of The Ten Outstanding Young Men (TOYM) by the Jaycees. He was also included in the United Nations Environmental Programme’s Global 500 Roll of Honor.

A graduate of the University of the Philippines and Harvard Law School, Oposa founded the School of the SEAs (Sea and Earth Advocates) on Bantayan Island in Cebu, where he holds workshops and seminars.

“The school,” he said, “is an experiential learning center for sustainable living.” It is powered by renewable energy and recycles waters and solid wastes.

Together with volunteer fishermen, divers, scientists and ordinary citizens, Oposa organized the Visayan Sea Squadron in order to protect marine life in the Visayan Sea, one of the richest marine sanctuaries in the world.

Oposa also worked hard to establish the so-called maximum sustainable yield (MSY) that sets limits to commercial fishing in the Visayan Sea.

His argument: People cannot have everything to their hearts’ content and end up with what he calls “tragedy of the commons.”

“We are all losers that way,” he said.

New worlds

UP and Harvard Law, as well as seeing the rape of Mother Nature, unmade Oposa’s old horizons and broke open new worlds that lay hidden, in much the same way that life-altering events in his youth brought him to his deepest core and forced him to contemplate the crossroads before him.

Coming from a well-to-do family in Cebu, Oposa led a charmed life in his youth but also relished a Robinson Crusoe-like lifestyle on Bantayan Island.

He was a law student when a fire broke out in their ancestral home in Cebu, scorching big portions of his body. The tragedy turned his life around.

Oposa is the author of two books on the environment: “The Laws of Nature and Other Stories” and the authoritative compendium “A Legal Arsenal for the Philippine Environment,” a must-read for lawyers who want to defend Mother Nature.

“There was one thing I really cared about—nature,” he said years ago in an interview. “I have seen blast fishing and all forms of abuse of the sea.”

He sought the advice of legal experts and got interested in environmental law. But the question in his mind was: “Who will pay me my fees, the fish?”

In behalf of children

In 1988, Oposa got a scholarship to study energy planning and the environment at the University of Oslo in Norway.

When he came back, he thought of suing the government using the concept of “intergenerational responsibility.” This meant lawyering to preserve the environment in behalf of children and generations to come.

The lower court judge ruled that children had no personality to sue, and dismissed the case. But the Supreme Court ruled that children had the right based on “intergenerational responsibility.”

The landmark case is now discussed in environmental law subjects all over the world, according to Oposa.

“For me, law is a tool, a thinking tool to guide human conduct,” said Oposa, who thinks he might have had ADHD (attention deficiency and hyperactivity disorder) in his childhood when the condition did not yet have a name.

“I was not in love with law when I started off,” he told the Inquirer.

Unconventional

But then Oposa is not a conventional person. He is drawn to distant sounds and marches to different music.

For example, when his Harvard Law classmates picked him to deliver the graduation valedictory, he did not dwell on the law. He gave a speech titled “On Friendship and Laughter.”

And at the gala dinner hosted by the Ramon Magsaysay Award Foundation for the awardees, he regaled the audience by singing “Usahay” (Sometimes), a Visayan song.

Oposa is married to Greely Remulla, an accountant, with whom he has four children—Juan Antonio, Anna Rosario, Jose Alfonso and Jaime Agustin.

He continues to serve farmers and fishermen’s groups pro bono and is a consultant to governments and international agencies.

Oposa often quotes anthropologist Margaret Mead: “Never doubt for a single moment that a handful of thoughtful and committed men and women can change the world.”

In his stirring speech at the awarding ceremony, he said: “Together we will spark the natural genius of Filipinos and of Asians and restore our respect for the sources of life. Yes, we Filipinos and Asians are geniuses in our love for Nature. After all, we live in the richest and most beautiful country, and region, on Earth.”

(Those who wish to add their names to the 10 Million Movement may contact The Law of Nature Foundation at thelawofnaturef@yahoo.com)

Batangueña refuses to pay taxes

A good friend of mine, Emma Alday, refuses to pay her taxes. She has not paid a cent for four years now. Emma is a guardian of the environment and has worked very, very hard to clean up rivers and other waterways in her hometown of San Jose , Batangas. I have seen for myself the efforts she has put into her advocacy.

A former nun, Emma is an NGO worker who has received a number of citations for her work among farmers. She runs Casa Rap, a small garden-restaurant that serves organically grown food plus art from nature’s excess. She is also a former municipal councilor who fought to get the local government and the citizenry to act on environmental issues, among them the severe pollution of rivers by poultry raisers.

I have written several articles to highlight the issues that plagued that part of Batangas. And so did many others in both print and broadcast media. The problems remain.


Lately, the Bureau of Internal revenue (BIR) has been knocking on Emma’s door to get her to pay her taxes. She was also asked to explain her refusal to pay. Many taxpayers would certainly sympathize with her. Here is Emma’s letter to the district revenue officer.

“Peace! This letter’s intent is to explain the reason why four years ago I stopped paying taxes, except the realestate tax. Long before Casa Rap was conceived, Susi Foundation, of which I am the chairperson, has been an advocate for environment protection and development.

“In the 1994 election, I ran and won as a member of the Sangguniang Bayan (SB), with the hope that I could help address the environment degradation caused by the massive livestock production owned by at least 30 percent of the residents.

“In 1998 we had a typhoid fever outbreak. President Fidel Ramos declared our town under a state of calamity. This caught the attention of the media. The issue was on the front pages of the dailies and was broadcast in almost all TV stations, but this did not move the hearts and political will of both the local and national government.

“All that the town got was a P500,000 check from President Ramos and the attachment of an automatic chlorinator to our water source, which more than doubled the chlorine content of our drinking water. Since then majority of the residents have stopped drinking tap water that comes from the Malaquing Tubig natural spring. Most resort to buying bottled water for health reasons. We now have four refilling stations in our town. This crisis provided livelihood opportunities for water station owners while poor residents (especially those who cannot afford bottled water and filters) are exposed to constant danger of all kinds of diseases. Considering that our water source is a natural spring, this neglect of the government is indeed a crime.

“As an SB kagawad I was a failure. My resolutions remained in the minutes. The environment ordinance passed in 1992 has never been implemented till the present. We appealed to the SB more than 10 times and to the Sangguniang Panlalawigan (SP) twice, but our voice fell on deaf ears. I have been trying to meet with Gov. Vilma Santos as early as when she was mayor of Lipa City through her secretary, common close friends, and the media, but I got no response. Now we have a party-list congressman representing the feed millers of the country but he and his family are major polluters of the Salaban River .

“For five years I was faithful in paying my business tax. It is hard to understand why the Department of Health is so concerned to have our lungs cleared but it does not do anything about the pollution that can make us sick.

“So I asked myself, why I am paying a government that does not care about the health of the people? There is no more point in lobbying, rallying, carrying placards, going around town, denouncing the apathy of the rich and the local government units. We have done all these and even more.

“We are cleaning rivers ourselves so that the poor residing nearby would have a place to bathe, do their laundry and have fish for their meals.

“But what awakened the local government? It was my non-payment of the business tax. So I am glad. Somehow something has been triggered, but they don’t dare ask why. All they discuss lengthily is that I am going against the law.

“Historically, Malaquing Tubig River is our town’s foundation. The river, with its generous ever-flowing springs, made travelers reside near it. Thus a town was born. Now this town has become the dump of volumes and volumes of chicken and hog manure. Worse, on our foundation day, the celebration was centered on the town’s recognition as the Egg Basket of the Philippines .

“A landmark at our town’s entrance was installed early this year. It is ONE BIG WHITE EGG. I can’t help but think of it as proof of the ignorance of our officials of our town’s history.

“At the SP meeting a board member said, ‘Don’t expect things to happen overnight. It will take time.’ Isn’t 17 years of lobbying not enough for them to respond to our urgent concerns? There is reason behind every law. Taxes are paid so that those who sought positions to govern would be able to render the necessary services to their constituents. Negligence, non-implementation of laws especially those that protect citizens from sickness and death is a bigger crime than refusing to pay taxes because of government’s non-performance.

“I welcome the consequences of my stand. My wish is that as a result of this, I would be able to witness during my lifetime the day when our town will regain the fresh air and clean rivers that we enjoyed when we were young.”