In the name of health

Always keep ithaca in your mind. To arrive there is your ultimate goal. But do not hurry the voyage at all. It is better to let it last for many years; and to anchor at the island when you are old, rich with all you have gained on the way, not expecting that Ithaca will offer you riches.

If compared to his relatively long career in public health spanning 29 years, "Ithaca" might as well be the "Ligtas Buntis" campaign being strongly advocated by Health Secretary Manuel Dayrit.

The poem of Greek classicist Constan-tine P. Cavafy is one of his favorites, says the literature buff. And as the well-loved piece speaks of journeys, Dayrit’s life in the professional world is certainly one that is rich in experience. The learning continues, as do the controversies.

The life of the man put on the spot for his free-will driven stance on the issue of family planning is not even close to "boring", as he puts it.

Dayrit reluctantly casts the Ligtas Buntis campaign as his "personal crusade" in a country overwhelmed by poverty and a swelling population. But the self-confessed introvert is not at all hesitant to give a lecture if only so the public can better appreciate what he is trying to do... all in the name of health.

"At least it’s being talked about," Dayrit says of the "Ligtas Buntis" program, which, not surprisingly, has drawn varied, mostly negative, reactions from this predominantly Catholic nation.

The word ligtas itself can mean more than just "safe" in a country as diverse in culture and dialect as the Philippines. It could be translated as freedom, saved, even avoid.

But Dayrit strongly clarifies the month-long Ligtas Buntis campaign this year–lovingly themed "Natural... Dahil Mahal Kita"–is not rooted in population control.

"We are talking about family planning, even responsible parenthood. Our paradigm begins with the notion of health–the health of mothers and children," he stresses.

"We are talking about women who want family planning service but are not able to get it. Part of this campaign is to identify who these women are and to actually provide them the service–whether it’s counseling or advice–on natural family planning, or on contraceptive methods, or others including pregnancy services," he adds.

The campaign guide for health workers distinguishes two concepts for the public to better understand what Ligtas Buntis is about.

Ligtas na pagbubuntis, means safe pregnancy and childbirth. On the other hand, ligtas sa pagbubuntis means safety from risk or unwanted pregnancy.

The "mindset" of the person, Dayrit says, also has to be determined. "Where is the person coming from, the background." In short, there is not just a single approach to planning one’s family well.

In a nutshell, this nationwide health campaign of the DOH is described as a "strategy to increase the visibility of family planning as an essential public health service."

The campaign’s guiding principles are responsible parenthood, birth spacing, informed choice, respect for life and privacy and confidentiality.

It is also undertaken to improve the access of couples, women and men alike to family planning and safe motherhood services. Its secondary target includes adoloscents, many of whom these days face the tremendous risk of complications arising from unwanted pregnancies and childbirth. According to DOH statistics, teenagers who go through child bearing have increased from nine percent in 1993 to 11 percent in 1998.

How does the DOH go about the massive campaign which, Dayrit says, especially aims to reach far-flung areas? Through the painstaking process of holding general assemblies in communities in coordination with the municipal government.

That is essentially the only way to reach as many Filipinos and, more importantly, to allow them to somehow break the assumption that sex education is taboo.

Dayrit says he finds community assemblies effective.

"When you talk to them, discussions, they learn from each other and they start thinking," he says.

Ultimately, the choice lies in every person.

"What we’re telling them is if you’re poor, we can help you. Don’t have a child every year, it’s bad for your health. If you want more children, let’s space it every three years that way you have a chance to have them survive. Eventually you could still have many children and you have a better chance of seeing them all grow old," the DOH chief explains.

"That’s a totally different attitude from somebody who says, ‘we have an overpopulation problem, let‚s only have two children’. What we’re saying is the choice of natural or artificial, it’s up to you." Dayrit emphasizes.

And freedom of choice–an informed choice–will come about if the public is educated on the subject of fertility and family planning methods.

A recent survey commissioned by the DOH, showed that only 30 percent of Filipino adults use family planning methods.

The worst part is that another 30 percent "have no clue of their reproductive processes," Dayrit says. "Another 30 to 40 percent who began using contraceptives have stopped, because they got sick, experienced side effects, or their husbands made them stop."

The most popular contraceptive is the birth control pill, followed by intraurine devices, withdrawal method, injectable contraceptives while some have undergone litigation. Surprisingly, despite the wider awareness on condoms, only two percent of the 1,200 respondents polled use it.

Having gone around the barrios early in his practice, the 54-year-old Dayrit was exposed to the mis-education of people, particularly women, as to their reproductive system.

Armed with his passion to immerse himself in community work, Dayrit decided to leave Manila for an internship in Davao after graduating from the UP College of Medicine in 1976.

"I totally re-invented my track," he says. "It was a year (intership). After that, I was enticed to work in the community instead of going back to the hospital to do residency, also in Davao."

He recalls talking to the wives of farmers and asking them what they know about their menstrual period. Their reply shocked him.

"They thought the blood came from all over the body, and from the skin, it came out. They didn’t even know. Some of them know they have bahay bata, but that’s about it," he says.

"You have a large number of people who are poor and didn’t have education, so how do you expect them to understand the reproductive system unless you reach out to them?" Dayrit points out.

He lived in Davao for eight years doing community work, and for a year in between, did a masters course in London focused on community health.

Public health is my specialty, Dayrit says. "And disease control. It is not a clinical expertise, not one-on-one. I am essentially a population-based control worker, I control epidemics in a population, I develop public health programs."

Dayrit’s father, Dr. Conrado Dayrit, a cardiologist, was a UP pharmacology professor until his retirement. Despite the presence of such influence from his old man, the eldest of eight children says it was his choice to become a doctor.

"He didn‚t market medicine to me, or to us. We eventually decided," he says, referring to his youngest sibling who also took up medicine.

Dayrit is married to a physician and has two daughters, one going on 15, the other going on 12. Talk about proper birth spacing.

Mindsets & Stumbling Blocks

Dayrit calls himself a "compensated introvert."

Being a "private person" in government doesn’t quite mix, but the health secretary manages to be at ease with the attention by making sure he knows what he’s talking about.

"I wouldn’t have made this presentation two years ago. It evolves in the understanding of issues, of politics," he says after giving STARweek a refresher course on reproductive health 101.

The Philippines has a population of close to 84 million, ranking it as the 12th most populous country in the world. This is expected to grow to 118.4 million by 2025 and to 147.3 million by 2050.

The Church wields considerable influence on policy issues and campaigns against officials who promote artificial contraception.

The proposed legislative measure limiting families to only two children has been shot down by practically all sectors of society.

Apart from the Church, advocates of population control–including a couple of legislators themselves–and even staunch upholders of having abortion legalized make their voices heard.

"I have taken special attention to this. This is so emotional and controversial. Reproductive health was not my cup of tea. I was a disease control person but now it has become an issue, for me intellectually, that I really point out these (differences)," Dayrit notes.

Dayrit knows the issues of family planning and population management could cause confusion unless the two are distinguished properly–and not fused together like how Congress wants it.

"Population management should not be lumped with family planning," he says. "Congress wants to make sure there is budget for contraceptives. That’s essentially where that boils down to. Their mindset is, there are so many poor people who can’t afford to buy contraceptives, and government has to distribute it."

Sure, the DOH will give out contraceptives, but the main premise he insists, is health. "And don’t expect us to distribute it discriminately."

He cites that while the strong campaign for the use of contraceptives works in rich Thailand, it does not necessarily mean it will do the same for the Philippines. Besides, he corrects the "fallacious" assumption that Thailand is developed just because they have a contraceptive distribution program.

People should not forget, he says, that Thailand has a good economy to start with. "They build farm-to-market roads and they don‚t have an archipelagic structure like ours. We have 7,000 islands, it’s so hard to travel from island to another. And we are multi-language."

Overpopulation may play a part in the poverty level of the Philippines, but Dayrit stresses that what drives a nation’s wealth is by "creating centers of industry".

"You’re not going to create wealth just because you reduced your population," he says.

In its initial stages, the DOH says the Ligtas Buntis campaign has reached 25 percent of its target of two million women and men across the country.

In the data submitted to DOH regional offices, a total of 519,906 of the "targeted women and men of reproductive age nationwide" have been identified as health workers.

"They say that the uptake for family planning services has increased by 19 percent based on what is happening in the last two months (of the campaign). They estimate it from the reports from the field on the baseline on how many people are actually using family planning," Dayrit says.

"You give a target on how many people you want to reach, but how many will eventually opt to take family planning and so on and so forth, you will know when you actually provide them (with the service)," he adds.

The Ligtas Buntis campaign will end on March 31 but Dayrit says it doesn’t mean family planning services will stop.

"Think of this as a promo period. Promoting little hype but after that, it doesn’t mean you stop the campaign. The expenses, however, are now limited in terms of the promo and maybe do another promo a year from now, or re-package it," he says.

Controversies die sooner than later, until something happens to revive it. But the DOH may get at least a breather as it moves on to promoting its other major programs.

The Ligtas Buntis is among the top DOH programs. The others are focused on disease control and pharmaceuticals, social insurance, disease control (such as TB, pneumonia, malaria, HIV-AIDS), maternal and child health.

"We’ll probably do immunization again, Vitamin A supplementation after this," he says.

There are a lot of DOH programs on women and children, he says, while other projects have to do with chronic diseases and healthy lifestyle.

"We also have pharmaceutical programs in which we try to develop initiatives to bring down the cost of medicines. We also have a program that tries to increase the social insurance of people so that they have a safety net," he says.

What Drives Him?

Fending off criticism while striving to get the job done can be daunting and taxing for anyone, especially a public official.

How does he cope? Apart from a gamut of interests, Dayrit has a knack for Zen meditation and tries to get into it as often as he can.

"I self-study Zen meditation. I even went into Tai Chi for a while," he says.

He plays the piano for himself, although was once shoved into the limelight for a fundraising activity organized by his classmates in college. "It was a nerve-wracking experience but I got through it."

Dayrit listens to an "eclectic" range music from classical to Brazilian to pop. He confesses he "doesn‘t get" the prevalent pop music like rap starting in the 1990s.

Tender, passionate songs are more his type.

He likes the music of Romantic period composers Chopin and Tchaikovsky, and adds: "One of my favorites as well is Rachmaninov."

"A lot of romantic songs were composed from classical music," Dayrit says, as he starts humming an Arthur Rubenstein classic from a Chopin piece.

"I listen to a lot of music and once even read its history if only to understand the time periods for music," he says.

He reads a lot of books and prefers non-fiction. Apart from reading poetry, he dives into books on psychology, history, philosophy, self-help and socially-relevant ones.

Dayrit, more known for his fondness for basketball and swimming as well as keeping a healthy lifestyle, writes a bit of poetry every now and then, and was into haiku for a time, although his pieces were "for his eyes only".

"Yes, I do try to write poems but nothing that I had published. I am not prolific in that sense. I wish I were, you know, like the words would just flow out of you."

He says he comes out with a piece every now and then. "When I‚m in the zone."

Dayrit finds time to make music his sanctuary if only to nourish his soul amid a busy schedule. And outside the confines of public service, his journey takes him to more inward nourishment.

And has he attained Nirvana? "I think self-awareness, I think it’s always evolving. But I think I’m in better control of myself and my emotions now compared to say, 10 years ago."

Wherever his varied pursuits take him–done most in the name of his passion for public health service–it is certain, like in Ithaca, that it will be a beautiful voyage. All our journeys are no matter the distractions and losing one’s his way.