Philippine Society of Geriatric Medicine
President’s Message
PGMA's Speech
during the 8th Annual Convention of the
Philippine Society of Geriatric Medicine
Centennial Hall, Manila Hotel

Thank you. Thank you very much Secretary Duque.

Our very young President of the Philippine Society
Geriatric Medicine Dr. De La Vega, our Convention
Chairman Dr. Alejandro, our friend from Okinawa Mr.
Itokasu, Executive Director of the AIM Policy Center
Poch Macaranas, delegates to the annual
convention of the Philippine Society of Geriatric
Medicine.

And may I give special acknowledgement to the
doctor who introduced me to the value geriatric care
Dr. Emmanuel Gatchalian. He came into my mind
when I got the invitation to be here with you today.

And I am glad, I’m glad to be here with you today. I
see people from the Philippines. People from all
over the world who have the passion to improve the
quality of life of our elderly. This is so important for
us Filipinos because Filipinos unlike the Japanese
are a young population. And so, most of our
resources are concentrated on how we can take
better care of the majority of our population who are
young. But I thank you for being here for being a
reminder that  we must take care of the elderly even
though their population is not as large as the
population of our young people in the Philippines.
And we officially recognized this.

strengthening our social safety net including better
access to health care, job training and care for our
elderly. In that same State of the Nation Address I
asked Congress to pass legislation that brings
improved long term care for our senior citizens. And
today that we are here together, I ask you who love
our elderly to help our administration draft the
appropriate legislation.

It is said that the Expanded Senior Citizens’ Act
which is passed during our administration is one of
the best in the world. But we want to make it even
better.

Subject to your advice, the legislation I am thinking
of is one that will increase the number of older
persons who will go through a geriatric health
screen, especially screening for geriatric syndromes
such as urinary incontinence, memory and affective
illnesses, height and weight determination, and
hearing evaluation.

The legislation I am thinking of is one that will put
more money in the hands of the older persons for
medicine, for medical care and provide some form
of pension for more of them. I’m glad that Poch is
here and concerned about the elderly because even
if he’s not a doctor, he knows finance and he knows
management. And that second part of the legislation
that we need is not really health care itself but how
to access health care. And maybe A.I.M. can help us
work on that as well.

But aside from the lack of money which is a very big
factor, it also seems that there’s lack of knowledge
about health issues in old age that prevents an
elderly person from seeking a sustainable health
care program. So I propose that the Philippine
society of geriatric medicine with the help of our
friends from all over the world join hands with the
department of health in propagating knowledge
about these issues. This convention is a very
important way of doing that and let’s take the
momentum and continue to spread that awareness.

There’s also an apparent lack of trained health
professionals in the field of geriatrics and
gerontology. There’s inadequate research on key
issues pertinent to old age.

Only four medical schools I understand, offers
special geriatric content in their curriculum: the
University of the Philippines, the University of Santo
Tomas, St. Luke’s – that’s why Dr. Gatchalian was
telling me all about it, St. Luke’s Medical School and
Cebu Doctor’s University. In fact, upon the invitation
of Dr. Gatchalian many years ago before I became
president, I had the honor of being the one to
inaugurate St. Luke’s Geriatric Care Center. And
seeing what I saw there, I felt then I still feel now that
we have to expand the field of participation.

Among state universities I am told that U.P. Manila is
the lead agency for institutionalizing geriatric
training. But as I said we have to expand the field. So
this morning, I was talking to Secretary Duque and I
think Dr. Duque that we should help U.P. Palo in
Leyte, University of Northern Philippines and
Mindanao State University to develop geriatric
training. And I hope the society will help us to do
that. Tomorrow I will go to Leyte because we’re
going to have a conference on peace. In Leyte, they
have been very successful in bringing down the
insurgency but at the same time I have asked my...
Those who were doing the advance work for me to
include among the activities that I will be doing in
Leyte a meeting with the head U.P. Palo so that we
can discuss how to develop geriatric training in U.P.
Palo. And I will be bringing with me a check of one
million pesos so can they do the start up of
developing their curriculum.

Meanwhile as we develop this relatively stronger
state universities as we help them to develop
geriatric training, we ask your society and we ask
our friends from around the world attending this
global conference to join the DOH, in training
national and regional program coordinators to
cascade your knowledge to the front line health
providers among our local government units
because the department of health is devolved the
provincial health officer, the municipal health officer,
the rural health worker – they are all reporting to their
local government executives rather than to the
Department of Health. Let’s all work with them,
cascade whatever we all know collectively so that
they can help to increase life expectancy.

Earlier, I was listening to what Dr. De La Vega was
talking about. And I had read about Okinawa earlier.
How I wish that someday, first of all, we have to
become first world like Japan but we are trying on
the verge of first world in 20 years. And of course,
other first world countries are not as good as
Okinawa but maybe indeed someday and it’s good
to have a dream. I wish that someday we could be
like the prefecture of Okinawa which has the most
number of centenarians in the world. And the
biggest percentage of centenarians in the world as
well.

And I am told that in Okinawa even at a hundred or
so years, they still go out to tend vegetable farms,
walk to the market, and in the evenings go out for
folk dances. I have seen a few of such examples in
the Philippines. Some very outstanding 90-year olds
who are still very active. I’ve seen some of them still
sing in the programs of women’s groups or the
older person’s groups. But there are very, very small
percentage but the fact is this women that I’ve seen
93 years old, 95 years old still active, our women
who have been able to have at least a comfortable
middle class life. So if they are able to do that and if
the institutions around us will be able to do that even
for the poor then we will see more of them even if we
don’t necessarily reach the proportions in numbers
of Okinawa.

We would like to see a significant number of our
own population in this situation where at a very ripe
old age of 90 at least still go to the market, still walk
and still go to folk dances.

Indeed, a great deal needs to be accomplished.
First of all we need to go as I said, to the verge of
first world and we hope to do that in 20 years. But we
need not wait 20 years before we improve our old
age health care. We can begin today. The
Philippines remains committed to doing this, to
vigorously pursue active measures that I have
mentioned earlier to create a “society for all ages”.

Many of us want to live a ripe old age. So, let’s all
join hands to bring about the day when everyone
who grows old will have a kind of care that will allow
them to age gracefully and productively.

Thank you for reminding us to care for the elderly.

Click this link for the complete speech of Dr Ramos in Manila Bulletin
December 2007


Medical tourism is a buzzword in the health industry nowadays.

And as I was pondering on what to talk about for my professorial lecture
on the Philippine Society of Geriatric Medicine (PSGM) annual joint
convention I happened to visit the web site of Philippine Medical Tourism.
To my disappointment I did not see "geriatrics" or "geriatrics services" in
the list. So I decided, it’s probably time to push the "geriatrics cheese".

To those uninitiated, Geriatrics is a branch of medicine that deals with
clinical, preventive, rehabilitative and social aspects of health and illness
in the elderly. In the local setting, 60s and above will fall under the
category, whereas in the industrialized world, 65s and above is the cut-off
age.

In practice, geriatricians deal with patients who are mostly 75 years old
and above with multiple chronic diseases. The so called geriatrics giants
such as, dementia, depression, falls and fractures, osteoporosis,
malnutrition, and incontinence. Most of these diseases are results of
frailty and needs assistance from others to carry out everyday activities.
Though geriatricians also sees patients in the hospital acute wards,
emergency rooms and/or out-patient clinics, it is in the Long Term Care
setting that they assume their dominant role.

Long Term Care is a spectrum of health services that encompasses the
continuum of care outside acute care or hospital setting. It includes, but
not limited to services such as, nursing homes, home health services,
day care centers and other residential care.

To have a rough estimate of how much LTC would cost, in 1999, a year in
a nursing home averages more than $ 40,000 and can exceed $ 100,
000 annually in some parts of the country. Imagine with inflation what the
rates are now. We don’t have any local data, however, I would say that it
is lot cheaper.

Home-based care is also expensive. Bringing a home health aide into
your home every other day for a four-hour-visit can easily cost $ 1,800 per
month. When the home care approaches eight-hour-visits everyday, the
costs rise to $ 7,200 per month. At this point, the care is shifted to
nursing or institutionalized settings for economic reasons.

Needless to say, Long Term Care is expensive in developed countries
and a potential target for Medical Tourism.

Medical tourist vs. sick and frail elderly

Obviously there is a distinction between a medical tourist and a sick
older patient. A sick elderly who is bed-bound or wheelchair-bound with
some degree of dementia or cognitive problem can hardly be considered
a tourist not even a retiree. They are actually patients who need Long
Term Care facility and services.

But how then can they be considered as target for Medical Tourism?

Allow me to cite Japan as an example and I quote Mr. Eisuke Sakakibara
otherwise known as Mr. Yen, a renowned international economist. He
commented on the aging problem of Japan just before he retired in 1999
as the senior finance minister. He said, " Japan’s aging problem should
be regarded as a regional problem (Asia), countries like the Philippines
with excellent health professional and caring people can take care of
Japanese elders who are sick with chronic diseases."

He further said " If only Japan will allow its government health insurance
to be used outside Japan then this can happen, tourism industry in these
countries will benefit most, since these patients will have families and
friends to visit them on a regular basis therefore solving the problem of
seasonal influx of tourists."

Simply put he singled out our advantage and strength. First, "our caring
people, educated, trained, English speaking health professionals".
Second he pointed out the opportunity, "bring in the sick elderly for LTC
then their families and friends will follow". The potential target for medical
tourism and perhaps the retirement industry included, I definitely agree
with Mr. Yen. This, I propose, is the interface of Geriatrics and Medical
Tourism and perhaps the Philippine retirement industry.

The Philippine Retirement Authority (PRA) presented the "young" retirees
45 to 59 years old as their priority target because of its sheer number and
perhaps their spending capacity, by 2010, there are estimated 869.1
million of them, simple arithmetic they said, considering that only 10
percent (86.9 M) of them are actually thinking of retiring outside their own
country and assuming that less than one percent of that 10 percent will
actually be convinced to retire here, PRA predicts the arrivals of 859,250
retirees. Nice figure indeed, but how do we intend to convince them to
come to the country when we have competitions from other developing
countries not to mention other developed countries who have started
years ahead of us in realizing their potentials as retirement havens. Even
for medical tourism, competition is suffocating, the other medical
institutions in India and Thailand has gained over us by virtue of being
years ahead. We are playing catch up game.

Why not target first the parents of the young retirees, I suggest another
arithmetic for this, supposing that 50 percent of those 45 to 59 years old
(869.1 M) still have living parents who maybe 70 years old and above, you
will still have 869.1 M targets because you have two parents.

We should not only focus on "housing" to jump start the retirement
industry as what PRA chairman Gen. Edgar Aglipay has been promoting,
perhaps the reason why most of those in the forefront are real estate
experts. We should look at the option of focused Long Term Care for sick
elderly to jump start the industry. We should convince those running
major hospitals and medical center to venture and invest in Long Term
Care services because of its exponential effect of bringing in generations
of relatives and friends of the older patient from different countries. These
relatives could be your captured audience to showcase what other
services you have to offer.
2nd E Gatchalian Professorial Lecture
by Miguel Ramos, MD, PhD