Monthly Archives: June 2015

Interview: Manuel Chua Chiaco, Jr., MD (Cardiovascular Surgeon, Educator, Administrator)

Chua

We were looking for Dr. Manuel Chua Chiaco, Jr. in the whole Philippine Heart Center complex while he was doing his rounds, and immediately we recognized him by the way the security guard saluted as he exited one of the buildings. One knows nobody gets that kind of a sharp salute in a government institution unless one is the President of the Republic, or the executive director of that particular institution. Before I get to him, he catches one of the young consultants and told him: “We have some doctors from the provinces coming. My only request is whatever you think of them, you teach them, you give them the best of what you know. That is my only request that you guys do while I am director of this hospital.” Then, finally, we got his attention. We explained our purpose there, and asked if it’s possible to get an appointment. He agreed. But it took weeks trying to set up an appointment. There was a back and forth between us and his secretary. And we never really succeeded until we just walked in one day with a formal letter for an invitation for this interview, and he had the time, but not until he finished his conversation on the phone, informing somebody that, if this patient based in the Visayas would be charged P2MM as a private patient in a provincial private hospital, and P1MM in a public hospital, then the patient could come to the Heart Center, or better yet Dr. Chua Chiaco is willing to get himself on the plane and fly to the province, at less than 1/3 the price of what the patient was being charged in the best public and private hospitals in the Visayas.

Sunfu: What is exciting you in your field right now?

That we are bring Heart Center quality cardiology in the far flung provinces is what excites me right now. People in the rural areas cannot get the care they need there, and they have to come to Manila. . A governor told me they have a P200 million hospital, but no doctors. They have the structures, but they don’t have anyone to man them. We have identified places where we can put our efforts, and we have started with Cagayan de Oro. We talked to the director of the Northern Mindanao Medical Center. We told him: give us doctors, we will train them, so long as they go back and practice in Cagayan de Oro. We have finished training two cardiologists, three cardiac surgeons, two anesthesiologists have gone back trained in cardiac anesthesia. So by the middle of this year, you have a complete complement of doctors that can give the same quality of care you can get here at the Heart Center.

Sunfu: Isn’t that too grand a claim? Equal the quality of care of the Philippine Heart Center?

No. Our idea with former health secretary Dr. Enrique Ona is to build regional heart centers all over the country. We are going to the extent of naming this place in Cagayan de Oro as the Philippine Heart Center of Northern Mindanao. There is a branding there. We are ready to stake a claim that they are going to receive the same kind of care that they will get if they go to the Philippine Heart Center in Manila.

Sunfu: Is there an assumption that medical training of our doctors is even, regardless of location?

No, there is no evenness. Granted there are bad medical schools. No way can a medical school do well when you only have three students for the whole medical school. We also have too many schools. But we should also not abandon them and say they are not trainable: it just doesn’t follow. In fact, the farther they are from Manila, the higher priority they should get in training in the Heart Center.

A lot of our educators cannot get rid of the notion that they will only train the smartest. I don’t believe in that. I believe we need specialists and we need a lot of specialists outside Metro Manila, regardless of how they started their medical education. Being the smartest is not enough, or sometimes it doesn’t even mean anything. We can train them to be good and effective cardiologists is enough; they don’t have to be the best. But also, please, don’t think they have no chance of becoming the best.

Sunfu: Any other qualifications aside from geographical distance?

At this time, geographic distance from Metro Manila is our priority. We have Philhealth, but we don’t have the doctors out there for the marginalized; so there is no access to facilities, qualified doctors, and the right equipment; if so, in that particular area, Philhealth doesn’t mean anything.

Sunfu: How about the elite in these far flung areas? They will still come to Manila?

Yes, but the goal is for them to be confident enough that even they don’t have to come to Manila.

Many good surgeons in the country have trained in the Heart Center, and regardless of where you come from, we give you the same training. I am confident those we have trained will get more and more proficient as they go along. But of course there will be disappointments. There are those who are bright and have what you think are qualities of becoming a great surgeon, but it doesn’t happen all the time and you can’t explain it. That is part of being an educator. Davao already has a very good cardiac group there, and Cebu has a thriving cardiology community: these are Heart Center-trained doctors. The people there or near there, they don’t have to go to Manila or abroad for any heart procedure or diagnosis.

Sunfu: But you still mention centers of commerce: Davao and Cebu. Not yet Tawi-Tawi, Basilan, Samar.

That is where we need government support. Cardiac diseases are very expensive to diagnose and to treat. It requires a lot of training, extensive training, and it requires expensive equipment, not only to buy the equipment, but to maintain these equipment: sometimes it is more expensive to maintain them than to buy them.

Sunfu: This is where you may part ways with some of our friends in public health advocacies. They will ask why they should support you when there are areas in the Philippines where schistosomiasis is still a reality.

This is where the whole reality of the problem in the Philippines comes in. We cannot ignore that what you are saying is part of the reality, but if we look at the whole reality, can we deny that our people have cardiology problems and that it is on the rise? We go back to education, to prevention, and in the meantime we leave those who are sick alone? I agree: we have many basic problems, but we also have many diseases that need to be addressed and basic education and sanitation will not solve them. Do we just ignore them? We pretend this person has no coronary heart problem? This is a lifestyle disease, but this is also a genetic problem. Do we want a situation that only those who can go to the United States will be able to address cardiology problems? We cannot just go for vaccination to solve the health problems of the Philippines, although that is certainly part of the solution.

Sunfu: Some of our public policy advocate-friends admire their mentors in PGH because some of them like Nelia Maramba, Romy Quijano, Art Pesigan, Isidro Sia pushed them to go out of Metro Manila as part of their medical education training. Do you like this method of encouraging our medical students to serve in rural areas?

Yes, but you see many of these doctors leave for the provinces when they just finished their internship. They still lack the experience and expertise.Many go to the provinces filled with idealism, but when reality strikes home, when they get married and have children, many will reutrn to Manila because they want their children’s education in Manila. Those who stay in the provinces and rural areas, many also do not anymore pursue a specialization. My argument is we need more specialists in the rural areas, we need to get more doctors, more specialist doctors, out of Metro Manila. Metro Manila doesn’t need more doctors. This is why I always hope, regardless of who is secretary of health, he or she will go to the rural areas and see the health situation of the Philippines with these far flung areas in mind.

Sunfu: What can they do for us in the United States in cardiology that we can’t get here in the Philippines?

Nothing. If you are talking of surgery or diagnosis, it is the same. Up until the 1980s maybe, many of the rich still had to go to the United States for their heart surgery. No more: they don’t need to anymore, and fewer are going. Imagine when I trained in the US in the 1977, one of my professors said: why are you coming here to train for coronary bypass surgery? Is that going to do your country any good? We are far from those kinds of questions already.

Sunfu: What made you come back to the Philippines from the US?

I never wanted to be in the US.

Sunfu: Many PGH people don’t come back from their training in the US.

No, PGH people still come back. But I guess you are correct: many don’t comeback. We also have to admit, the concept of doing something for the common good is getting to become less and less important in the lives our countrymen, or even globally.

Sunfu: Was it important when you were young?

Yes, definitely. My father, who was a medical doctor of the Chinese General Hospital, a cardiologist, I cannot remember him at any time not thinking of the common good.

Who was the most influential doctor in your education?

That is an easy question: cardiac surgeon Manuel Tayao is my biggest influence, because he was technically simply an excellent surgeon. He took me under his wings. Part of the confidence I have now in my profession is because of my training from Dr. Tayao.

Sunfu: Do you come from a family of doctors?

My father was a cardiologist, and my son is a cardiologist, and he finishing his training in the US. He will be back soon. And I think he will be a better doctor than me or my father.

Sunfu: Spoken like a true father.

(laughter)

Sunfu: Who are the cardiologists you would trust with your life?

Dy Bun Yok and Rody Sy. My son. Just as my father trusted his life to no one else but me, the time he needed bypass surgery, he would have it done only if I would do the surgery. In the same way would I trust my life to my son.

Sunfu: There is the Sunshine Act in the US that has changed the pharmaceutical industry. What are your views on the pharmaceutical industry in the Philippines in relation to the medical community?

Well, the intention of bringing down the prices of medicine is very important. In the United States pharmaceutical companies are not even allowed to give out ballpens. Here in the Philippines I like to see more of this happen, or at the very least, I think we should draw the line between needs of the work place, like big conferences that need the assistance of big companies, and personal needs, like the need for a driver on a Sunday morning to go to the market, for example. Doctors should be very conscious of this line. But realistically, there are many things the medical community cannot afford if it is not supported by pharmaceutical companies, like conferences or brining important speakers from abroad to the Philippines. No doubt some companies have also been so aggressive that doctors become beholden to them. Some doctors have become very dependent on these big companies. That is too much. Slowly, we must move away from that dependency. For the medical education of the community, I am still okay with that. Personal needs or wants, there should be no more room for that.

Sunfu: How have you changed in your four years as Executive Director of the Heart Center?

I used to be focused on the problems of the Heart Center, and now that I work with legislators and regional hospital administrators, I realize the solution is not to solve the problems of the Heart Center, although there is that which we need to attend to, but the problem is much bigger: we have to go out of the Heart Center in order to address some of the biggest and most urgent problems. In the local level here at the Heart Center, we have patients from the provinces come here at 4AM to fall in line, and we get overwhelmed every day. Fixing this problem in the Heart Center level is not going to work, it is not enough.

Sunfu: Any lessons you did not know before you got this executive position?

I am fully convinced there is no reward in working for government.

Sunfu: Psychological rewards for doing good?

More frustrations than rewards, really. Cabinet secretaries get maybe P80,000.00 a month. It’s a lot of sacrifice when you consider what most of them were getting before they joined government. I have heard of marriages breaking up because of the sheer demands of life in government. If you intend to work in government and be honest, you must accept that indeed it is going to be a big sacrifice.

Sunfu: Well, the two times we saw you moving around, we saw a man with a lift in his walk because you seem to have a strong sense of purpose in your work. Is this a wrong impression?

I am a man with a purpose? Ok, but happy? No. This is a big sacrifice. Is it stress? No, not stress, as stress is everywhere and it will depend on how you handle or take stress. I think the environment to do excellent work is just not there. You are held back or weighed down by naysayers. I was still new as executive director, and I already had five cases filed against me with the Ombudsman. The threat to the institution is not from without, it is from within. As I said earlier, the concept of the common good is hardly there anymore, and it is not happening only in the Philippines, it is everywhere.

Look, Philhealth is very good, but the threat is also from within, from doctors. Doctors are earning good money already, but why make false claims in Philhealth? I cannot understand. I tell young doctors do not look at the health problems of your patients as a business opportunity. It is not a business opportunity. I believe in the old Chinese concept that you don’t have to make a killing in one transaction to earn, you do not overcharge. I have been faulted for interfering on the professional fees of doctors, but I feel they are charging too much.

Sunfu: Maybe the Philippine Heart Association is the venue for this. Are you an active member?

I never had a major role in the Philippine Heart Association. I think it has lost a lot of its social relevance. At one time I told a president of the PHA that we should do something about the ethics in the practice of cardiology, but he said we will step on a lot of toes if we touch on that subject. And that answer made me lose interest in the association. I began to see it as a social club. Maybe there are too many doctors, maybe competition is just too much, and some feel you have to take short cuts in ethics to get ahead. So I tell young doctors: don’t forget the very reason why you became a doctor. Nobody should become a doctor to get rich. Don’t lose your idealism. Illness is a misfortune that befalls our patients, it is not a means for us to get rich. Doctors are not meant to be businessmen. Do not lose the sense of compassion. A lot of doctors will not like what I am saying, but this is what I see. I tell the young graduates they must strive hard to uphold the dignity of the profession.

Is the Heart Center in the black?

Yes, we have been in the black for a few months now. There was a time we were in the red for maybe 15 years.

Sunfu: How do you assess PGH?

PGH is really out there in the front line solving the problems of the country, and I am sadly out of touch with the PGH, but I am happy to hear they have a big budget now, which should be able to make them go about their work more effectively.

Sunfu: We always end our interviews by asking what books or authors you would like to share with our readers?

I don’t like autobiographies and history books. I like fiction more. I read Scott Turow, Richard North Patterson, Nelson DeMille, Richard Russo. I read for entertainment. I don’t like self-help books, how to gain wealth and influence people books. I used to read medical journals, and now I read them only to fall asleep. Two pages and I am out. I got the book MBA in Ten Days when I assumed this position, but I am almost done as Executive Director, and I haven’t opened the book yet, so I am still not an MBA. Oh, there is an autobiography I like. Stolen Lives by Malika Oufkir, which is about living a charmed life in Morocco and being imprisoned in a penal colony for 20 years when her father was implicated in a plot to assassinate the king. It is worth reading and I am going to lend you the book. When I go to a bookstore, I look for the seal that a book has been chosen by this or that reliable book club, and it helps me shorten the process of looking for something that may be new, or interesting, or just plain entertaining.