Unlocking the powers of STEM CELL THERAPY from aesthetics to cancer cure

By Ramil Gulle and Joyce Alumno

Even if one takes away the hype, there are a lot of reasons to feel hopeful and excited about stem cell therapy. Aside from the rejuvenating wonders that celebrities talk about, stem cells, when gathered from safe sources and used the right way, present effective treatments for a variety of diseases, including Parkinson’s Disease and Multiple Sclerosis to Type 1 Diabetes, to many types of cancers (even leukemia) and heart disease, to plastic and reconstructive surgery, and many orthopedic ailments.

At least five hospitals in the Philippines have departments dedicated to stem cell therapy. The Cellular Therapeutics Laboratory at the Makati Medical Center, the Institute for Personalized Molecular Medicine at The Medical City, National Kidney Institute’s Molecular and Cellular Therapeutics Laboratory in collaboration with Lung Center of the Philippines, and St. Luke’s Medical Center.

Stem cell facilities of these five Philippine hospitals use stem cells from the safest known sources: bone marrow and peripheral blood from the patient himself or herself, or from human umbilical cord blood.  In cases where the patient, for one reason or another (the patient is too young, or too old and frail), cannot use his or her own stem cells, donor stem cells are harvested, usually from siblings, parents and other close relatives.

As mentioned earlier, stem cells must come from the safest sources possible to achieve the best treatment results. Besides bone marrow and peripheral blood, another safe option is umbilical cord blood.

One provider of cord blood and tissue banking services in the Philippines is CordLife Philippines. It is, in fact the first and only cord blood processing and cryopreservation facility in the country that is built according to global standards. It is ISO-certified and registered with the Philippines Department of Health.

CordLife Philippines is part of CordLife Limited, a network of state-of-the-art stem cell banks in the Asia-Pacific region that has facilities in India, Indonesia, the Philippines, Singapore, Hong Kong and China.

 American cancer survivor Dr. Sumathei Selvaretnam with Dr. Sam Bernal narrating her experience in getting stem cell treatment in the Philippines and how the therapy saved her life more than seven years ago.

Futuristic cures

Neurosurgeon Eric Flores, M.D., head of the Cellular Therapeutics Laboratory of Makati Medical Center, has said that stem cell therapy is “the future of medicine.”   Molecular biologist and oncologist Sam Bernal, M.D. who heads The Medical City’s  Institute of Personalized Molecular Medicine, has said that stem cell therapy ushers in the age of truly personalized molecular medicine—meaning, medical science is moving in a direction where treatments are customized to the individual patients using medicine that is engineered at the molecular level.

According to Bernal, stem cell therapy begins with a “molecular profile” of a patient. “No two cancers are alike. Each cancer patient is unique. In order to find the exact cure to that patient’s cancer, we look at the molecules of that patient’s  tumor, for example, and find the right medication and the right treatment that is customized to treat that tumor,” he said.

Cancer bombs

The way stem cells work against cancer is a lot like science fiction warfare, as Bernal tells it. First, the stem cells are engineered to become what are called dendritic cells. These dendritic cells have been engineered based on the molecular profile of a patient’s cancer cells. When these specialized dendritic cells are released in the patient’s body, they start hunting the cancer cells. These dendritic cells are very specific: it’s like a lock-and-key mechanism. These dendritic cells will only lock-on to the cancer cells that they were designed to identify and search for. Once both dendritic cells and cancer cells lock on, the dendritic cells activate the patient’s T-cells.

The T-Cells are the immune systems hunter-killer cells. The dendritic cells that lock on the cancer cells allow the T-Cells to find the cancer cells. Once a T-Cell finds a cancer cell, it engulfs the latter. The T-Cell then releases hydrogen peroxide “bombs” into the capture cancer cell, which causes the cancer cell to explode.

“We get cancer all the time,” said Bernal, “but most of the time, our immune system finds these cells and destroys them.  However, there are cases where the immune system fails to recognize cancer cells. When the immune system fails to do so, that’s when cancer develops and spreads and becomes a life-threatening illness. So, essentially, stem cell therapy boosts the body’s capacity to identify and destroy cancer cells that were previously unrecognized.”

Bernal pointed out however, that stem cell therapy is presently used as an adjunct to chemotherapy. So has to undergo both chemotherapy and stem cell therapy for the most effective treatment.

On the other hand, according to Dr. Flores, stem cell therapy also helps a cancer patient recover from chemotherapy’s toxic side effects. According to him, stem cells are “used to repopulate the blood and bone marrow with normal blood elements after ablative chemotherapy in the treatment of such conditions as leukemia, multiple myeloma Hodgkin’s and Non-Hodgkin’s Lymphoma.” Thus, the cancer patient undergoing stem cell therapy is able to tolerate chemotherapy better.

Two patients who underwent stem cell therapy in the Philippines are Sumathei Selvaretnam, M.D. an Internist from Florida, USA, and Ateneo Professor Ed Morato, Ph.D.

Dr. Sumathei had been diagnosed with ovarian, kidney and pancreatic cancer. She underwent her stem cell therapy and chemotherapy at The Medical City and she is now in remission. “As a doctor, I was understandably worried about my condition when I received my diagnosis. But I am happy that with this new treatment, I was able to go into remission and hopefully, I will continue to be in remission,” she said.

Professor Ed Morato, Ph.D. did not have cancer but he did have a serious heart condition that made him very weak and out of breath. It was so serious that one cardiologist he consulted basically told him to prepare for death—that he should create his “bucket list” and do the things he always wanted to do before dying. At the time, his breathing was so difficult that he had an oxygen tank in his bedroom. He needed to breathe in the oxygen from the tank every night when he slept.

Morato, however, refused to give up. He heard about stem cell therapy at a party and decided to give it a try. “I have always been intuitive about my health. So when I felt that stem cell therapy was right for me, I did it even though my other doctor had already given up on me. Today, Morato has recovered from his heart condition enough and is able to go back to teaching and he no longer needs his oxygen tank.

These amazing recoveries from serious illness are just a few of the successful cases of stem cell therapy. Dr. Flores of the Makati Med talks about one-year-old children awaken from a coma after stem cell treatment, walk a year later, and attend school as if nothing happened in 3-4 years. He also said that back pain and degenerative joint conditions have been eased significantly by stem cell therapy, as well.

Amazing as stem cell looks for now, even more amazing treatments are on the way as medical science further harnesses the power of these cells in step with the progress of the medical science and technology behind it.

HOW SAFE IS STEM CELL THERAPY?

Stem cell therapy is getting a lot of buzz nowadays thanks to stories from the media about how Filipino celebrities, including politicians, are availing of its benefits. This treatment, which involves injecting stem cells into the human body, is being offered as a treatment for cancer, heart disease and other serious illnesses. It’s also being used to counter the signs of aging: making skin healthier and wrinkle-free and rejuvenating the body’s organs for more youthful vitality.

There are several sources for the stem cells that are being used to treat patients. These include bone marrow and peripheral blood—usually taken from the patient himself or herself—and from umbilical cords. All of these, the bone marrow, blood and umbilical cords, are taken from human sources.

However, there are also cell therapy treatments that use, believe it or not, animal cells. Proponents of this therapy claim that these animal cells are “purified” and are therefore safe for injection into human patients. These sources of cells or stem cells, however, are still controversial. In short, they do not have a track record of safety or effectiveness when it comes to treating human illnesses or the signs of aging.

Recently, Department of Health Secretary Enrique Ona gave out a warning related to the use of cell therapy. According to him, not all sources of stem cells are equal: there are those that still have no evidence of being safe or effective for use in patients.

Secretary Ona said that there are only three sources of stem cells that have a record of proven safety and effectiveness: human bone marrow, human peripheral blood; and human umbilical cords.

“We already know today that the safest and most effective cellular preparations are those that use the patient’s own cells—called autologous human cells. Thousands of patients worldwide have been treated over several decades with autologous human cells and their safety and efficacy is well established, especially those derived from bone marrow and peripheral blood. Umbilical cord stem cells also have a long track record of safety and efficacy,” he said.

All other sources besides these, according to him, must be treated with caution:

“In the meantime, the public should be careful about receiving cell preparations that are being offered in the Philippines and elsewhere, such as embryonic, aborted fetal, genetically altered, and especially animal stem cells,” he said.

Secretary Ona also said that these sources of stem cells “still need strict regulatory assessment before they are allowed for human use in the Philippines” and that he has formed a special task force to develop guidelines on the regulation and use of stem cell therapy in the country.

Other doctors have also warned against the use of animal cells for the treatment of human diseases.

In its website, The American Cancer Society says that the use of animal cells in humans carries a lot of risks.

“Cell therapy may be dangerous, and several patient deaths linked to the therapy have been reported in the medical literature. Patients can contract bacterial and viral infections carried by the animal cells, and some have had life-threatening and even fatal allergic reactions. Other reports list complications such as brain swelling or the immune system attacking blood vessels or nerves following cellular treatment. Serious immune system reactions resulting in death have also been reported. Women who are pregnant or breast-feeding should not use this method, as its possible effects on a fetus are unknown.”

The American Cancer Society also differentiates between the use of animal cell therapy from the use of human cell therapy:

“It is important to distinguish between this alternative method involving animal cells and mainstream cancer treatments that use human cells, such as bone marrow transplantation.”

Furthermore, the American Cancer Society says there is still no solid evidence that the use of animal cells in humans is actually effective.

“None of the therapeutic success claimed by cell therapists has been documented through scientific testing and published in peer-reviewed medical journals. Claims of the therapy’s success take the form of individual cases, testimonials, and publicity issued by practitioners of the therapy. Even supporters of cell therapy admit they do not know how cell therapy works in the body. No reliable evidence has been published in medical journals to support the claims of cell therapy.”

All told, it is very important for every patient to distinguish between animal stem cell therapy and human stem cell therapy because only the latter is recommended for use in the Philippines because of its proven safety and benefits.

REFERENCES:

·         http://www.mad-cow.org/jul99_news.html#ddd  “Sheep cell injections 'of no benefit to children”

·     http://www.cancer.org/Treatment/TreatmentsandSideEffects/ComplementaryandAlternativeMedicine/PharmacologicalandBiologicalTreatment/cell-therapy

·        Unproven methods of cancer management: Fresh cell therapy. CA -- A Cancer Journal for Clinicians 41:126-128,1991.

·         Slide presentation, Institute for Personalized Molecular Medicine, The Medical City

·         “Cellular Therapeutics Laboratory and Stem Cell Treatment Frequently Asked Questions (FAQs)”, Makati Medical Center

·         “MakatiMed’s Cancer Center celebrates first year with launch of Cellular Therapeutics Laboratory: New laboratory sets the standard for world-class treatment”

·         “Cellular Therapy”  http://chealth.canoe.ca/columns.asp?columnistid=3&articleid=2902

Royal Treatment at the Philippine Heart Center

Iso Nanhken Iriarte and Madam Ruth Iriarte at the Philippine Heart Center suite room

IT’S NOT EVERY DAY THAT A PHILIPPINE HOSPITAL TREATS ROYALTY, but that’s what happened when Iso Nanhken Iriarte and his wife Nahnkeniei, leaders of the kingdom of Pohnpei of the Federated States of Micronesia (FSM) went to the Philippine Heart Center. Iso’s wife needed to have some diagnostic procedures done on her heart and they chose to go to the Philippine Heart Center.

Nahnkeniei’s non-royal, birth name is Ruth Iriarte and she is a Vice-President of the Bank of FSM. She gladly shared her experience as a patient at the Philippine Heart Center. She said that it was okay for Filipinos to call her by her birth name—but in Pohnpei, calling her by that would be a disrespect to her status.

“We chose to go to the Philippine Heart Center because of its expertise. Also, during my stay here, I feel very much that the doctors and nurses here really care for me. I feel safe,” said Ruth.

She said that there was a suggestion for her to go to a medical facility in China. However, she preferred to go to the Philippines for several reasons.

“First of all, Chinese culture is very different from that of Pohnpei and the other islands in Micronesia. Our culture and that of the Philippines are very similar. Also, Filipinos speak English very well,” she said. Pohnpei, Ruth explained, is a territory under the administration of the United States and the currency there is the U.S. dollar. This means that she and her husband are able to change their dollars to pesos in the Philippines.

Her husband, Iso Nahnken, said that the exchange rate between the two currencies lowers the cost of their travel and medical care in the Philippines.

Ruth is very appreciative of how the doctors, nurses and other medical staff treated her. “They treat me very well. They are very friendly, very caring. I feel cured! I can feel their emotions, I see that they care. To me, having that kind of relationship is very important.”

Iso Nahnken echoed Ruth’s sentiment. “In FSM, there are Filipino doctors and they also check on us. They were the ones who recommended that we go to the Philippine Heart Center.”

The royal couple also found their hospital room comfortable enough for both of them to stay there instead of a hotel. “I find it very comfortable and safe. I like it better here than in a hotel,” said Ruth.

Iso added that he found staying at the hospital very convenient. “The accommodations are all right. The space is big enough for us to stay in. It’s easy to get whatever we need right here at the hospital,” he said.

The even shared a very interesting story about the Philippine Heart Center involving Iso’s brother. According to them, Iso’s brother went through cardiovascular surgery ten years ago at the Philippine Heart Center. The brother was extremely pleased at how his Filipino cardiologist and surgeon attended to them.

“My brother felt that his cardiologist and the rest of the medical staff at the Philippine Heart Center treated them like family. He felt that his doctor was not only treating them as patients—he said that he was practically a parent to him when he was here.

“The doctor operated on my brother on the same day that his son was born. And so, when the baby was born, they named the baby after the surgeon. That boy is now ten years old, and his name is Charleson, named after the doctor,” Iso revealed.

By mid-2012, the Philippine Heart Center will be the first in the Philippines and third in Asia to have the Hybrid Operating Room

Filipinos first

According to Dr. Gerardo Manzo, the Philippine Heart Center’s Assistant Director for Medical Services, the Philippine Heart Center treats about 350 to 450 foreign patients a year—a small number compared to the 13,000 Filipino patients that the facility is able to treat on an annual basis. However, he said that the PHC would not mind being able to treat more foreign patients, since this still benefits their facility’s Filipino patients.

“That is where we try to balance things. Whatever subsidy the Heart Center gets from government, all of it automatically goes to the charity wards, to be spent on the patients there. The rest of whatever revenues the hospitals gets is spent on salaries, operations and maintenance costs. Now, whatever extra earnings the hospital receives--from medical tourism, for example--also goes to the Filipino patients in our charity wards. So in the end, our Filipino patients are still the ones that benefit.

“So, if we were to send a message to foreign patients, it would be that if they go for treatment at the Philippine Heart Center, they would be receiving quality, compassionate and patient-focused care from an internationally accredited, world-class cardiovascular facility—and at the same time, they would also be able to help Filipino patients of limited means to receive the same type of care. That’s a good thing—the ones that can afford medical care are able to help those with lesser means,” Dr. Manzo explained.

He added that the Philippine Heart Center does not charge separate rates for foreign patients and Filipino patients. Both groups are charged the same rates, and these rates are published in the hospital’s website at www.phc.gov.ph.

And yet, the Philippine Heart Center has not been actively marketing itself as a world-class cardiovascular facility, which is exactly what it is by now after it was awarded a Gold Certification from Accreditation Canada International in August 2011.  The accreditation, according to Manzo, was not done for foreign patients—it was sought primarily to ensure the quality of the Philippine Heart Center’s service to Filipinos.

“Let me make it clear that the Philippine Heart Center is here primarily to provide medical care to Filipinos. All of the improvements we’ve made to bring to world-class levels the quality of our facilities, equipment, medical and surgical treatments, operations and services have been done--and will continue to be done--to benefit Filipino patients. Now, if foreign patients wish to come to us for treatment, then we will admit them because we are sure that we would be able to treat them here,” he said.

Recently, the Philippine Heart Center acquired the very first Lighting Room in its ICU; it is the very first in Asia and only the second in the world. The Lighting Room has its lights operated by software that follows the human circadian rhythm, which aids in treating patients by making sure their natural rhythms of rest and recovery are maintained.

The Philippine Heart Center will have, by mid-2012, the first and only Hybrid Operating Room in the Philippines and only the third Hybrid OR in Asia. A Hybrid OR is a highly-advanced and complex working environment for large teams of surgeons, nurses, anesthesiologists and technicians. The Hybrid OR allows all the members of the medical team to work efficiently and seamlessly together, which greatly increases the success of the surgery for the patient.

Dr. Manzo said that the Philippine Heart Center currently has 382 rooms and will soon be expanding to 450 rooms. “We want people to know that the Philippine Heart Center is always doing its utmost to continually upgrade its facilities and services, in order to serve our patients better.  This is our lifelong commitment.” he said.

Prices of Selected Medical Procedures

Diagnostic Procedure/Treatment	Package Rate	Length of Stay
Cardiovascular Check-Up	P20,500 – P23,000	24 hours
Executive Check-Up	P35,700 – P38,500	48 hours
Coronary Angiogram	P48,200 – P65,000	3 days
Right & Left Catheterization	P63,000 – P94,000	3 days
Pacemaker Surgery	P101,224 – P210,152	4 days
Aneurism Surgery	P394,912 – P561,224	7 days
Coronary Artery Bypass Grafting	P405,040 – P1,156,640	8 days

*Includes cost of hospitalization, medication, operating room and professional fees.  Does not include cost of blood and/or screening of blood products and cost of Intra Aortic Balloon, Graft for Peripheral Vascular Bypass, Cardiac Rehabilitation, Pacemaker, Introducer Sheaths an Complication of Surgery. 
For complete list of procedures and package rates, please visit www.phc.gov.ph

Health Care is for All

By Joyce Socao-Alumno and Ramil Gulle

ONE FREQUENTLY ASKED QUESTION when discussing Global Healthcare Travel also known as Medical Travel or Medical Tourism is this: Will the country’s public healthcare be compromised once the Philippines becomes a global healthcare hub? The short answer, based on the experience of India and other more established medical tourism destinations is: No, as long as we do it right.

Universal Healthcare or “Kalusugang Pangkalahatan” is a priority program of the Aquino administration. The Department of Health (DOH) will never lose sight of that. The thrust of the DOH is to make healthcare available to all Filipinos, especially for some 5.2 million families that have been identified as belonging to the poorest of the poor. That said, however, it does not mean that global healthcare travel is right away at cross-purposes with Kalusugang Pangkalahatan.

“Global healthcare travel brings its own benefits for the country’s economy, for our healthcare professionals and for our health and tourism sector. Universal healthcare vis-à-vis global healthcare need not be a choice between one or the other—both can benefit the country in each their own way,” explained Health Secretary Enrique Ona at the 1^st Philippine Global Healthcare Forum held at the National Kidney Institute Auditorium on November 2011.

Global Healthcare Travel: Addressing a worldwide need

What needs to be stated at the outset is this: the goal of “universal healthcare for Filipinos” is not necessarily opposed to what Medical Travel is, which is essentially seeking after universal healthcare but on a worldwide scale. Healthcare is a right not of individual nations but of all persons—this is precisely why everyone has the right to seek the best care possible and seek treatment anywhere deemed appropriate for one’s illness.

This is an activity that, based on existing studies and trends, will become even more prevalent. Why? There are several factors, including: 1) The rapidly aging population in many countries including the United States, Japan and Western European nations; an aging population means more age-related illnesses and ailments; 2) The rising costs of healthcare in the United States, Canada, Australia and Western Europe; 3) The rising number of patients in these countries who have no health insurance and thus, would not be able to afford their home country’s healthcare. 4) The overburdened social healthcare systems of these countries that can no longer effectively serve their populations.

The other factors are: 5) The availability of medical tourism destinations like India, Singapore, Thailand, Malaysia, the Philippines, and others in Asia; Mexico; South American nations like Colombia, Brazil and Costa Rica; some Eastern European destinations like Hungary, Poland, Slovenia, etc.; and Middle Eastern nations including Israel, Iran, etc.; 6) These medical tourism destinations provide healthcare that is of comparable, if not better, quality as the healthcare in patients’ home countries, at lower cost; and 7) The relative ease of global travel and availability of information—economic globalization has made travel across nations more convenient and with less restrictions and the Internet provides information for patients from many countries to “shop” for healthcare in nations other than their own.

All of these factors are making global healthcare travel a practical, less costly, and effective means for overseas patients to seek various forms of medical care and wellness treatments in places outside of their home countries. So many countries have already transformed themselves into medical tourism destinations and are reaping the economic and social benefits—without sacrificing the health of their own people. So there is no reason for the Philippines to be hesitant about providing medical care to overseas patients through its own medical tourism program—in fact, overseas patients have already been coming to the Philippines since the 1970s for treatments, even before the words “medical tourism” became a buzzword.

PHOTO COURTESY OF ST. LUKE’S MEDICAL CENTER FOR PHILIPPINES: THE HEART OF ASIA TRAVEL GUIDE

Public health and medical tourism

The challenges facing the Philippines in terms of public healthcare are considerable. There are an estimated 5.2 million families considered to be among the “poorest of the poor” and these are the most urgent beneficiaries of the Aquino administration’s Universal Health Care or Kalusugang Pangkalahatan program. These more than five million families, identified by the National Household Targeting System for Poverty Reduction (NHTS-PR) of the Department of Welfare and Social Development or DSWD, will receive the greatest benefit from UHC.

The lead agency that is implementing UHC in the Philippines is PhilHealth. It marks its 17^th anniversary as government’s health insurance provider with an even stronger push towards creating the infrastructure that will make UHC a reality for all Filipinos. Universal Health Care for Filipinos will be implemented through membership with PhilHealth.

The suite of benefits available through PhilHealth has also been modified to make Universal Health Care more effective in serving Filipinos’ needs. Notable among these are the Improved Primary Care Benefits and the No Balance Billing.

PhilHealth’s Primary Care Benefits package focuses on diagnostic and preventive services that members may avail of free of charge. Eventually, this benefits package will also include the most commonly needed outpatient medication such as drugs for hypertension, diabetes, and antibiotics. (More information on how PhilHealth is implementing UHC for Filipinos is available on their website, www.philhealth.gov.ph).

Now what part does medical tourism play in all of these? It does play a part, albeit indirectly. The most direct benefit that medical tourism plays in UHC in the Philippines is by providing funds that may be used for public healthcare benefits. Medical tourism, obviously, brings additional revenue to Filipino hospitals, clinics and other healthcare providers. Following a model that is already in place in India and Malaysia, the government would be able to give incentives to Filipino hospitals and similar facilities who cater to medical travelers, in exchange for a percentage of profits from medical tourism being channeled towards public health funding.

In other words, a portion of the earnings from medical tourism ought to be made available for use in providing public health facilities and services to the local population. This idea that those who could better afford health care should subsidize the health care of the less fortunate is neither new nor far-fetched. In fact, government hospitals like the National Kidney Institute and the Philippine Heart Center are already doing such a thing without compromising or discriminating the service provided to the Filipino patients.

Then there are the indirect benefits of medical tourism to public health. Any Filipino healthcare provider who wishes to provide services to overseas patients would have to meet international healthcare standards, if it wishes to compete with other facilities in India, Singapore, Malaysia, etc. This means that the Filipino hospital or medical facility would have to get accredited by a globally-recognized certifying body recognized by the International Society for Quality in Health care (ISQuA) like the JCI, NABH International, Accreditation Canada, etc. Applying for accreditation entails that the hospital must improve its facilities, equipment, operations and services to be of international quality.

This will, in turn, raise the standards of Philippine healthcare across the board, so that most, if not all, medical facilities will improve the quality of care that they give to Filipinos as well as foreign patients. This is not a far-fetched notion. We have the experience of India to look to as an example: when more and more hospitals in India improved their facilities, operations and services to meet NABH standards (created by their government under Quality Council of India which later got accredited by ISQuA), the overall quality of healthcare in India moved up, benefitting Indians and overseas patients—and raising the standards and the quality of the Indian public healthcare system as well.

Other indirect benefits of medical tourism have to do with creating more job opportunities for Filipino healthcare professionals (as our medical facilities expand to meet greater demand from local and overseas patients, not to mention the expansion and improvements due to increased revenues from medical tourism); and more income for the tourism sector, arising from the dollar-spending generated by medical tourism.

Fortunately, the present administration sees the complementary roles of both UHC and medical tourism. Hopefully, this sends a signal to Philippine medical healthcare providers to invest more of their resources in both medical tourism and public health.

Love as the greatest miracle

By Ramil Gulle

 “HE LOVED HER BACK TO LIFE” is how one colleague described what Chet did for his wife Margie, as they stayed for more than three months in India while she recovered from two near-fatal aneurysms. Their ordeal—and the miracles that followed—are all in Chet’s book “88 Days in India: A Pilgrimage of Faith, Hope and Love”

 LOVING AND EMBRACING LIFE. Chet (far left) with Margie (second from right) and their children, Catherine, Patricia, and Mark.

 HE DIDN’T HAVE ANY MONEY IN HIS WALLET on their first official date. He had invited her to the restaurant to celebrate his birthday—but as things turned out, she ended up paying for their meal. In terms of romantic etiquette, that was nothing less than a disaster.

And yet, it was this same guy, Chet Espino, who would spend 88 days in India caring for that same woman who paid for their meal—now his wife, Margie—after she suffered two aneurysms during her official trip there. Chet and Margie’s story is truly inspiring in both the romantic and spiritual sense. Their story is told in detail in the book “88 Days in India: A Pilgrimage of Faith, Hope and Love”; the book’s nearly 200-page length is a compilation of Chet’s daily e-mail updates, sent to members of an e-group created by her friends. The e-group served as a support network of prayers and wishes for Margie’s healing. It was a book that, as Chet says, had practically written itself.

The couple’s life-changing ordeal happened in November 2008 when Margie, as Business Features Editor of the Philippine Daily Inquirer, was invited by a private firm to cover the company’s corporate social responsibility awards ceremony. What was supposed to have been a four-day business trip turned for the worst when, during a trip through Faridabad, industrial district of the Indian state of Haryana—about an hour from the nation’s capital, New Delhi—Margie was stricken with an aneurysm.

The company flew Chet to India on November 29^th, where he finally joined his wife in the hospital. It was a desolate and frightening time for Chet, who had no clear idea of his wife’s condition, or even if she would still be alive once he found her in the hospital. He writes in the book:

“The 11-hour trip to New Delhi, including a lonely, five-hour layover at Singapore airport, was very frightening. There was always the fear of not knowing if I was going to find Margie alive in India… The bumpy ride from the airport to the hospital in Haryanna district was eerie. The haze formed by mist and dust that enveloped India let me know all the more I was indeed in extremely unfamiliar territory.

“Within an hour we arrived at the hospital in Faridabad. My heart beat faster as we made our way through the corridors and into the intensive care unit. Margie, my beloved wife of 17 years, mother of our three children, whom I kissed goodbye just days ago when I brought her to the airport in Manila, was there all right.

“She was in coma.”

Chet watched over and took care of Margie there for 20 days, until the time when it became urgently necessary for her to be moved to another hospital in New Delhi; it was the best facility available to treat her condition, which had become critical.

For more than three months while Margie was under the care of Indian doctors in New Delhi, it was an emotional roller-coaster ride for Chet and his teenaged kids who were left in the Philippines to fend for themselves while their parents were in India. Margie went through two aneurysms and had to survive further complications including hydrocephalous, meningitis, bedsores and bouts of infections.

Margie showed signs of recovery at one point, only for her to be confined in the ICU yet again when a second aneurysm struck, causing her brain to bleed. After she shook off, miraculously, the major clinical events that occurred, she still had to recover her normal brain functions. There were times when her brain could not process what her eyes were seeing. She’d lost most of her memory, even forgetting Chet himself. She told him at one point, “I’m a married woman.”

It was indeed a great struggle for Chet, Margie, her family and friends, until the day when she finally returned to the Philippines on February 26, 2009. It was a homecoming that was also still the beginning of more recovery, a slow resurrection back into the fold of her loved ones. She still couldn’t walk. She had to re-learn normal human functions, which meant painful physical therapy sessions.

“I used to wonder why we need to have a health card, but now, I’m using Medicard. Medicard has been taking care a lot of our medical bills. It’s good we have a health card now,” said Margie, who is still undergoing physicaly therapy and other treatments. Her recovery is ongoing, although the degree to which she has regained her health and functioning is just amazing.

The president of Medicard, Dr.Nicky Montoya, even visited Margie a few times at the hospital here in the Philippines. Chet and Margie recalled that they never knew he was actually the president of Medicard because he never introduced himself as such. It was only much later, to their surprise, that they found out that Dr. Montoya was not merely a representative of the HMO.

A deeper love

Fast forward to 2012. Margie is back at work, editing the Business Features section of the Philippine Daily Inquirer. She is still recovering—a fact that is made noticeable by a gimp in her left leg. Margie, however, is every inch a living, walking miracle. A recipient, according to her and Chet, of God’s miraculous providence—it was really God that pulled them through and restored Margie back to an amazing life.

Margie says that her love for Chet has grown deeper with the knowledge of how much he struggled to help her recover. Chet, on the other hands, says that he came away from the experience with the insight that in a marriage “it’s really not about what you can get from your spouse in the marriage; it’s about how much you can give your husband or your wife, and how you can keep on giving.”

It’s touching to hear them recount their story, three years after their experience in India—even when they joke about the times when Chet was courting her. She and Chet revealed that their courtship phase was marked by what could be described as a comedy of errors—mostly because of Chet.

Filipinos can learn a lot from the story of Chet and Margie, a story that is best told in Chet’s book. It’s a story of how a husband, who once couldn’t pay for his wife-to-be’s meal, was able to “love her back to life” as one writer put it.  It’s a story of how God works miracles in His own inscrutable way, to show us a model of true faith.

Inspiring medical care

The humorous anecdotes make the love story between Chet and Margie more human, more touching and more real. But there’s another story—besides the story of their faith and the story of their love—that one reads as a subtext in “88 Days in India: A Pilgrimage of Faith, Love and Hope”: it’s the story of how providential it was that Margie’s illness happened when she was in India.

Many of those who were receiving updates from Chet while he was with Margie in India were probably surprised at the quality of medical care that she was receiving. While the Indian healthcare system has been recognized as one of the best in the world for many years now, it’s still different to see it from Chet’s perspective.

Chet gives a grateful account of the competence and concern displayed by the Indian doctors and medical staff. Margie’s first neurosurgeon in that hospital in Faridabad was the pillar on whom Chet relied on for strength and hope when it came to her medical treatment. And yet, even the doctor had to admit that he no longer knew what to do next, when Margie had a second bout of bleeding when a second aneurysm struck.

Chet was very resistant of the suggestion that Margie be moved to the hospital in Delhi, fearing that a transfer would endanger her more. He only agreed after he had a husband-to-husband talk with the doctor. Chet asked the doctor, “If your wife was in my wife’s place, would you transfer your wife to this other hospital?” When the doctor said yes, Chet consented to the transfer.

The medical team took care of Margie in the hospital in New Delhi. It was at that hospital that Margie recovered from her complications and where she became well enough to be fit to travel back to the Philippines.

Learning from India

According to Chet, what struck him most was how the Indian doctors treated patients with a spirit of humble service. He explained that the Indian doctors who attended to them put on no airs, and even drove modest car models. And of course, Chet believes that the expertise of Indian medical care, along with faith prayers and God’s providence, was a big factor in Margie’s recovery.

Chet also mentioned that doctors in India are very aware that word of mouth about how they treat patients will impact the reputation of Indian medical care, and so they always strive to do their best—especially since India is now a hub for global healthcare travel or medical tourism.

So Chet’s book is also, in its own way, a story of how important it is for any nation to bring its healthcare up to excellent standards. Indian medical care took off to a new level when the government worked with private and public healthcare providers to raise and meet world-class standards. In India, this is done through accreditation with the National Accreditation Board for Hospitals and Healthcare providers or NABH, which is one of the international accrediting bodies under the ISQua (International Society for Quality in Healthcare) just like JCI and others.

 “It was the story of Chet and Margie that made us realize how good healthcare in India really is,” said Joyce Alumno, Executive Director of HealthCORE, a think tank for research in global health travel and now the country representative of NABH International.

According to Joyce, she was advocating along with DOT and DOH the quality of medical care in the Philippines for years, only to be awe-struck by the story of Chet and Margie’s experience in India.

“When I heard the story of Chet and Margie, I was very humbled upon realizing that, while the Philippines has very good doctors, nurses and other medical staff, our own healthcare system still has a lot to learn from Indian medical care,” said Joyce. She cited the fact that Margie was given first aid in a small lying in clinic in Fadirabad as an example.

“Margie and her companions were desperately pooling money in order to pay the clinic. They ended up paying only P6,000 all in all, and the clinic even gave them a bagful of medicines for Margie to use, which was good for few months’ supply. The incredible thing is, even a small lying in clinic in India is competent enough to give initial emergency to someone like Margie, who suffered from a potentially fatal aneurysm. That says a lot about the high degree of healthcare quality in India.

“If the lying clinic didn’t have the competence, then they would have failed in the initial emergency care of Margie—and who knows what could have happened. And they were able to help save her life—only at a cost of P6,000. Imagine if we could do the same thing here? Imagine what would happen if even small Philippine clinics gained the competence to provide quality care in potentially life-threatening illnesses—and at lower cost. If we could do the same thing, all Filipinos would benefit, especially the poor,” said Joyce.

The story of Chet and Margie inspired Joyce to go into talks with NABH of India to ask them to assist the Philippines learn from India’s healthcare system. These talks resulted in HealthCORE becoming the official Philippine representative of NABH.

Currently, NABH is working with HealthCORE in providing seminars and workshops to Philippine healthcare providers, to help them begin the process of upgrading the quality of their operations and services to become world-class like India’s. Philippine healthcare providers who attend these HealthCORE seminars and workshops also have the option to apply for international accreditation through NABH International, the global accreditation arm of NABH.

As Chet mentioned during this interview, “In life, there are no accidents.” So there may be readers out there who are encountering Chet and Margie’s story for the first time, or those who may have heard about it in passing. Well, it could be that Providence is leading them to a path towards renewed faith or simply to a source of inspiration in loving and living. In that case, it would be a good idea to get a copy of Chet’s book, which is a love story that we all need to hear about. 

Finding heart and home in the Philippines

By Ramil Gulle

AMERICAN BOOK  author and writer Beth Day, Spanish master artist Juvenal Sanso, and balikbayan lawyer and entrepreneur Loida Nicolas Lewis are all well-renowned and respected internationally in their respective fields they had no doubt in their minds that they wanted to make the Philippines….their home.

The General’s wife

Beth Day first became endeared to Filipinos after she married Filipino military general, patriot, book author, journalist, educator, diplomat and former President of the United Nations General Assembly (the first Asian and the first and only Filipino to hold the post, when he was elected in 1949) Carlos P. Romulo. They first met in New York City 1958, when she was assigned to write a feature story on him for The Reader’s Digest. Back then, she was a freelance writer and he was serving his term as Philippine Ambassador to the United States.

Romance blossomed between Beth and Rommy, as the General was also called, in 1972, when their spouses had already passed away. They were married in 1978. At the time, he was Secretary of Foreign Affairs under President Ferdinand Marcos.

Beth and the General were inseparable until the day he passed away in 1985. By that time, she had decided to stay in the Philippines for good. “I used to have an apartment in New York. I used to pay every month for it to be maintained even though I would only go there for a couple weeks every year. Eventually I put it on the market,” said Beth.

She has no regrets about choosing the Philippines as her home. “No doubt about it, I would definitely recommend the Philippines as a retirement haven. In fact, I think the Philippines is not being promoted enough,” she said.

She has no regrets about choosing the Philippines as her home. “No doubt about it, I would definitely recommend the Philippines as a retirement haven. In fact, I think the Philippines  is not being promoted enough,” she said.

According to Beth the best attribute of the Philippines as a retirement haven is the Filipinos themselves. “The friendliness of the Filipinos, especially towards visitors is without question. Even when I came here for the very first time in the 1950s, the Filipinos were very friendly, very warm. They are very helpful to visitors. If you need help with anything, Filipinos are glad to help. They’re very attentive and they love to talk,” she said.

Beth also noted that Filipinos speak English well enough for foreigners to enjoy good communication when they are here. “For anyone from an English-speaking country, the Philippines would really be a good place to choose for their retirement.”

Beth is registered under the Philippine Retirement Authority’s Retirement Program, where she is entitled to several benefits and privileges. Among these, she says that it’s the SSRV or Special Resident Retiree’s Visa, that she finds most useful. Foreigners with the SSRV have a much easier and quicker time going through Philippine immigration as part of their special privilege. “Believe me, when you travel alone like I do, it’s such a big deal when they make things easier for you at immigration. They practically wave you in,” said Beth.

Although Beth is now in her 80’s, she is not retired. She still writes columns and articles for a national newspaper, where she focuses on international relations; and she remains productive as a freelance writer. “There’s really no retirement when you’re a freelancer like me. I’ve always been able to work at home,” she said.

Master artist comes home

World-renowned painter Juvenal Sanso was born in Reus, Catalonia, Spain in 1929, moved to Manila four years later with his family, established himself as a painter in the 1950s, then travelled the world—making Paris his place of residence for 50 years. In 2008, he decided to return to the Philippines and what he calls his “beloved Manila.”

Now in his 80s, Sanso, as he is known the world over, is still very much the blond, blue-eyed young man—in heart and in spirit—who grew up in Paco, Manila, learned to swim in the Pasig River and spent family outings in Montalban, Rizal.

Sanso speaks Tagalog fluently, as well as Spanish, French, Italian and a few other languages. Having lived in Europe for decades, it is very interesting to know why, of all places—and yes, he could have stayed in Paris, of course—he decided to go back to Manila. Before he answered that question, however, he emphasized that he doesn’t consider himself retired.

“I am not retired. There is no retirement when it comes to what I do. Renoir, for example, continued painting into his old age, even when his hands were already twisted [by arthritis]. They had to tie the paintbrushes to his hands. But if you look at Renoir’s paintings during that period, you can see the delicacy of the strokes—no sign in his works that his hands were already crippled and in great pain,” Sanso said.

Nevertheless, he was gladly given his SSRV card by the Philippine Retirement Authority and enrolled in their program—granting him well-deserved privileges and benefits.

“The best thing about the SSRV is when I travel abroad and return here. It’s very easy to go through immigration at the airport,” said Sanso.

“The best thing about the SSRV is when I travel abroad and return here.
 It’s very easy to go through immigration at the airport,” said Sanso.

While he lived in France for 50 years, he never severed his ties with the Philippines, coming back to stay a few weeks at a time. In 2008, he finally settled here for good. Like Beth Day, Sanso loves the Philippines because of the Filipinos. He knows firsthand how friendly, hospitable, kind and compassionate Filipinos are.

Being a painter, Sanso also loves the natural beauty of the Philippines. “The Philippines is not the most beautiful place in the world. There are other beautiful places—but the Philippines certainly has a lot to offer when it comes to that. There are so many beautiful places in the Philippines. I remember one time, when we were invited to go to Calatagan in Batangas. On the way there, we couldn’t see much because of the fog, as there is fog at times through Tagaytay. But on the way back, wow. We could really see the view. Wow. Glorious,” he said.

Sanso also loves the food. “Well, the food here has a lot of influences, Spanish, Chinese, etcetera. It’s very good,” he said, adding that he loves the mangoes here, and considers them the best in the world.

Sanso may be Spanish by birth, but he spent his childhood in the Philippines and it was here that he learned the basics of painting from Filipino masters like Fernando Amorsolo and other teachers in the University of the Philippines and the University of Santo Tomas. It was also in the Philippines that he started what would become an international career in the arts. By now, he said, he has already become a Filipino at heart.

Balikbayan’s choice

Attorney Loida Nicolas Lewis is neither a typical balikbayan nor a typical retiree. Yet she has a love for the Philippines and the Filipinos that spurs her to share her blessings to them. She’s mostly out of the country every year, but she maintains her home and her businesses in the Philippines and always comes back for about two weeks, 4 times a year, to be with Filipino relatives and friends.

Loida is Chairman of TLC Group, Inc., a Delaware Corporation with private equity funds.  An attorney by profession—who is admitted to practice in both the Philippines and New York—she was the first Filipino woman to pass the New York bar without attending law school in the United States.

After her ten years stint as General Attorney in the US Immigration and Naturalization Service (currently U.S. Citizenship & Immigration Services), and having won her discrimination case against INS in 1987, she co-authored “How to Get A Green Card”, now on its 8th edition, a best-seller in its genre.

Her husband, the late Reginald F. Lewis was the first and so far the only African American who engineered the purchase of a billion dollar company-Beatrice Foods International on a leverage buy-out. The company shareholders received a 35%internal rate of return on their investments.

“Now that I have retired from business I always come back here in the Philippines as I am more comfortable here rather than in Forida or any other country.  I am a Filipino; born in the Philippines. I love Filipino food and Filipino  traditions,” she said. 

Loida graduated in the top 10% of her class from the University of the Philippines and is a cum laude graduate of St. Theresa’s College, two of the Philippines’ premier educational institutions.

She currently resides in New York City and is a registered member of the St. Ignatius Loyola Catholic Church. She actively sits as Member of the Board of the National Catholic Reporter, USP4GG, Apollo Theatre and Regiland F. Lewis  Foundation. She speaks several languages:  English, French, Spanish and Filipino.

She went into the business of hog-raising in Bicol and closed it in 2007. She invested in a mall  (Fernando Mall) and a hotel  (Fernando Hotel) to do her part in revving up  the fledgling but promising tourism industry in Sorsogon.

She also founded The Lewis College in Sorsogon in 1999 in memory of her late husband--she doesn’t consider this as a business but rather as giving back her blessings to her fellow Bicolanos. (For other information about the college visit: www.thelewiscollege.com

As a balikbayan, she considers retiring in the Philippines very ideal because of the hospitality of the Filipinos, and, of course, because she is among her people. “Filipinos have all the virtues I like: kind, hospitable, helpful, sensitive and compassionate. For a retiree like me, these are the best qualities of people I want to be around me,” she said.

While the Philippines has many beautiful tourism destinations, she believes that a visit to Sorsogon is a wonderful introduction to travelers who go to the Philippines.

“When my daughter got married last year in Intramuros, I invited relatives and friends from the US to attend, I brought them to Sorsogon where we visited San  Binon Hot Spring, Bulusan Lake and the oldest church in Bicol also in Sorsogon- St. Joseph Church. We even swam with the butandings (whale sharks). It was an exhilarating experience and they promised to bring their friends and relatives,” she said.

Loida is also an advocate of medical tourism because she believes that the Philippines has world-class healthcare. This, she believes, is of benefit not only to balikbayans like her, but also to foreign travelers seeking medical care overseas.

“Anything related to health is priced lower in the Philippines. For example, a specific service may cost $1000 in the US but if you’ll do it here in the Philippines, it will just cost you $100. So far, the services I had here in the Philippines were Medical examinations, Dermatological services and Dental care services. The doctors, nurses and other medical staff have excellent skills. They are very competent and very caring,” she said.

 “Anything related to health is priced lower in the Philippines. For example, a specific service may cost $1000 in the US but if you’ll do it here in the Philippines, it will just cost you $100. So far, the services I had here in the Philippines were Physical Examinations, Dermatology Services and Dental care services. The doctors, nurses and other medical staff have excellent skills. They are very competent and very caring,” she said.

Loida is currently working with a group on ways to amend US legislation, so that more US senior citizens, including those of Filipino descent, will be able to use their Medicare card to cover their bills when they avail of medical treatments in the Philippines.

Loida added, “The U.S. Medicare does not cover expenses incurred outside the US. With Eric Lachica as our lobbyist, we want the US Congress to amend Medicare law to allow Medicare Insurance to be applicable in the Philippines. This is known as US Medicare Portability.”

PHOTOCAPTIONS RETIREES STORY

Spanish artist Juvenal Sanso began his career as a painter in the Philippines and learned the basics of his art from Filipino masters. He continued his arts studies in Europe and lived in Paris for fifty years, making trips to the Philippines at least once a year. Now a world-renowned artist and recipient of the highest honors from the governments of Spain, France and the Philippines, Sanso continues to paint and produce his works at his home in Manila.

SANSO IN BAGUIO. World-renowned Spanish artist Juvenal Sanso during one of the many trips he took to the Philippines.  Over the past 50 years, Sanso has been going back and forth to the Philippines even as he travelled through Europe from his residence in Paris. In 2008, he settled in the Philippines for good.

HAPPY WITH THE GENERAL. Beth Day with husband Carlos P. Romulo, also known as “The General.”  Romulo and Day were married in 1978 when he was the Philippines’ Secretary of Foreign Affairs. They were inseparable until his death in 1985.

AT HOME WITH FOXY  - American writer and author Beth Day with her beloved French poodle, Foxy.  She sold her apartment in New York and chose to stay in the Philippines, the homeland of her late husband, Carlos P. Romulo, soldier, general, Philippine patriot, writer and diplomat, and the first Filipino and Asian to be President of the United Nations General-Assembly.