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
08 November 2007

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.

In my State of the Nation Address last July, I expressed the conviction that we must invest in 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


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 Sr.
Professorial Chair Lecture
by
Dr. Miguel A. Ramos Jr., MD, PhD