YL5 week 2 @ASMPH: Public Health to the Private Cell + The Malaise of Medernity

YL5 week 2 @ASMPH: Public Health to the Private Cell

Public Health to finish off Principles and Perspectives

The 2nd week in was a kind of transition in itself. The first half of the week was spent studying the public health module that will be included for the exam. Since it's quite over, I will just briefly summarize for the sake of memory rather than study. If you're interested in the reflection essay only, scroll down to The Malaise of Medernity.

The public health module talked about WHO approach to health systems as well as the Filipino's Fourmula + one project. We also had to learn about the top leading 10 causes of mortality versus morbidity. Really in this "principles and perspectives" module, the point is to appreciate them as they contextualize the learning of medicine. What stands out in studying medicine at ASMPH is what's different that surrounds the studying of medicine common to other schools? 

Another difference was the MBA part of the MD/MBA program. Last Monday, we got to meet our professor/coach, a sweet lady that got us thinking (in groups) about the similarities and differences between the MD and the MBA. One acronym I learnt is "VUCA", and how everyone started using it when each group elected a member to present the differences in this "VUCA" world. 

After that periodic break was the time to study for the exam on Tuesday. I honestly referred to last week's blog for study albeit its more casual nature. It's important, perhaps, to continuously find new ways to study the same material without getting bored. Anki is great and there's a huge following on it that started in this group. I'm not so convinced it's the be all end all, especially early on where one tries to get into the habit of long term learning from it. But the exam came and it went, and I soon found myself preparing for F2F classes that would occur the next day.

And I took awhile to prepare for it because I was informed around 9 pm that I had not been cleared to go on campus. Actually before that, the government had also announced that they were extending the modified extended community quarantine (MECQ), which put into question whether there was f2f classes to begin with. Nevertheless, I was determined to try to get cleared. It turns out that my doctor had not checked in the student health form that I was medically cleared. I had to scramble to find a doctor for a teleconsult. I got a contact from my parents, an internal medicine doctor, and tried to message him on text and on viber. I didn't hear anything and was resigned to accepting not making it to the face to face. 

A slight bump in the road to face to face classes

At around midnight, I was about to head to bed and I noticed it was September 8 already (albeit midnight). I prayed the angelus and greeted our blessed mother a happy birthday. Shortly after praying, I started to pack up in the study room to get ready for bed. I checked my phone to see if there were any announcements on our many messaging platforms ASMPH connects to us through (Viber, Telegram, FB, FB messenger, canvas, etc.).  When I got to viber I noticed that the same doctor who I pleaded had asked to meet and he shortly called me after on the telehealth "now serving" med app. I couldn't believe it but managed to put those feelings of excitement aside to get evaluated and finally get that check mark on the form. I thanked the doctor, with whom I exchanged a short talk about Georgetown's medstar hospital. 

Afterwards, I quickly sent the form back to the nurse who informed me of my not being clear. She said that the doctor responsible for clearing is asleep but thinks I'm likely cleared. With all this adrenaline and other things going on, I didn't sleep until around 2:30 am. 

I woke up early at around 6:30 am, thinking to myself never to sleep that late again. I laud my classmates who can make this sacrifice regularly. One of my batchmates had asked if I could pick them up and I agreed. After having breakfast, I left and picked him up for F2F classes. It was raining. I almost forgot that the quickness of the traffic isn't just due to the MECQ but also the fact that there's a typhoon that prompted an announcement of signal number 2, suspending class up to the high school level. 

Getting to see the campus was unreal. I was likely in denial, but also wary of all the protocols we had to do. I quickly went up to the third floor where I was assigned and met some of the "famous" people in the batch– i.e. people who got engaged in student council work early on. After chatting a bit, I went to my classroom. 

Our evaluator for our F2F classes was a recent graduate (2020). There were about 9 of us in the classroom (plus the instructor). Before "class" begun, I quickly prayed lauds on my phone using the iBreviary app; then we began. We first were welcomed by the health safety officer and our initial module coordinator over zoom presented across the classrooms. We were then shown demonstrations of how to don and doff the PPE. Meanwhile, our instructor was handing off our PPEs to practice with. Shortly after, we practiced them and were informed we had 3 tries to "get it right". 

I was the third to go. I normally get kind of blurred when it comes to performing things I just learnt but I saw the first and second person go and was like why not? Most of the steps were logical enough. When your hands are exposed, try to sanitize in each step of the way. Thankfully, I got through the first go. 

As everybody else in my class were being examined, our doctor instructor was pretty chatty and lightened the mood by asking us questions and sharing his experience at ASMPH. I learnt that many of my classmates here were interested in different things post graduation. One wanted research, the other wanted to do Doctors to the Barrios (DTTB) first, surgery and public health for the other 2. I had said I was deciding between internal medicine and neurology. The doctor used this as a stepping point for saying that our interests will change every module and every year and even 2 weeks leading to the physicians licensure exam. After some chatting, my ride was ready to go so I thanked the professor and bid my classmates adieu. 

My group and I had wanted to take a photo but it seemed difficult given the social distancing requirements so we decided against it. I then got the classmate who I picked up and dropped him off before heading home. Just in the nick of time, I got home, did the procedures post F2F and after showering logged on Zoom for the novena masses. I felt a small moment of happiness in being able to join the community in praying the mass for our board takers and also celebrate the solemnity of the nativity of the Blessed Virgin Mary. The mass was lovely, and I was ever reminded of my resolve to be here and the spiritual community that links me to the faith that sustains me. 

To the Private Cell

The rest of the day was free for us before we start cell module the next day. I took this opportunity to spend time with the people I care about a lot (virtually), playing a short hymn I learnt over this module (Take o Take me as I am by John Bell), and read a paper on causation in philosophy of medicine. This culminated in (virtually) attending the Manila Cathedral's healing rosary for the world. To be honest, it was quite slow and I passed out halfway through the 4th mystery after trying my hardest to stay up (kneeling, standing, etc.). I remembered I had slept late the night before and decided to head to bed shortly after. 

We started the cell module bright and early with an orientation at 8 am. The module coordinator greeted us and reminded us not to just rely on the transes but to read the book too. I'm quite a bookish person, hence why I note this. I'm trying to adapt to Ateneo's transes system but can't help but think it's a supplement (necessary but not sufficient) compared to the upper years emphasizing its eventual importance when the reading gets too much. 

I spent the first day of cell in a kind of flow. I read the recommended readings, watched the videos while on discord call studying with music and good but silent company (most of the time). I won't spend like last week trying to articulate it all but we covered the structures of the cell and the metabolic processes that occur there. The second half of the day, after a hearty lunch and novena mass (Saint Peter claver, slave of slaves pray for us), was on histology laboratory. I was initially intimidated as I recall my cell bio class in undergrad, I was pretty bad at pictures. Nevertheless, I watched the lectures and learnt about the process of histology through a light microscope. I tried to think about it colloquially. Preserving with formaldehyde/glutaraldehyde fixes it at its place. Then get it drunk by progressively feeding the tissue alcohol up to 100% concentration, which is particularly dehydrating, that we then need to clear of with benzene or xylene. With the alcohol cleared, we embed it with paraffin by baking it. After it's baked and ready to go, we section it off into a thin slice using a microtome, then proceed to use the stain we want to finish preparing the slide. 

I had to keep rewriting this for it to make sense to me. But it wasn't enough to just work on the recorded material or even the transes. I also sought out the resources and spent the evening reading the two required reading sources (if curious it's the first chapter of the Junquiera histology and the wheater's histology). I was going to go for the suggested one (Pawlina) but thought to use it the next day to study. I ended the day watching a short video on John Paul II on why it's important to know our nature, why we have yet another Manichean dualist problem going on in our generation, and the human person as embodied spirit. One summary take-away: "If we are spirits, then we are incarnate spirits"- R.A. Spinello.

The Malaise of Medernity

To poorly spell a phrase coined by the philosophy Charles Taylor as the title of this reflection is for pointing out the worries I have with medicine here at the Ateneo. It has nothing to do with the curriculum or the way in which the school adapts to varying degrees of spirituality by its community, but rather the underlying attitude of modernity that manifests this malaise. Taylor argues that self-fulfillment isn't necessarily a bad thing in modernity; some may call it the culture of narcissism or self-centrism. Rather, modernity's desire for self-fulfillment can be very good indeed but its malaise stems from it not squaring up with what is good and distinguishing it from what is bad and politically dangerous. 

I noticed this confusion in last week's lecture on medical anthropology when the lecturer mentioned "cultural relativism", which is good but he would never advertise something like genital mutilation as a cultural practice. One sharp student asked the question on the zoom Q&A when do we draw the line with cultural relativism. This lecturer merely restated that "of course we wouldn't endorse that". It seems to me that he was making an argument based on "common sense". But that isn't enough for many people because it itself breeds relativism at its core in terms of how to interpret what he says "of course". In one sense, one can say that if we pick up his cue on what "of course" means, then we have the cultural/moral high ground because we "get him". This just perpetuates the problem of cultural relativism– one culture that gets the "of course" of common sense gets to impose cultural hegemony on another. This is a post-modern confusion.

On another sense, he may be appealing to "reason" to distinguish what cultural norms are acceptable from what are not. This is a modern confusion. It's a confusion not because reason is bad; no it is good. But what is bad rather is that reason is badly understood. Modernity started off with emphasizing reason alone (sola ratio), that is the pinnacle of the "enlightenment" period. But as time passed by, philosophers started criticizing this "modern" project by pointing out that people wield "reason" to hold against people who do not. It's a form of cultural hegemony, in this sense. Those who know reason have power and those who don't know reason are powerless. In many places over many times during the enlightenment period, reason was abused, which led to an undercurrent of our age's new (yet actually same) "original sin" of distrust and disobedience to those who now dare to wield reason as an excuse. Reason alone is not enough. 

This is the "reductionism" we were taught to avoid last week in the principles and perspective module. To not make a "mind-body" dualistic error by separating off the biological from the "sociocultural" and the "psychological" aspect. Our very concept of health in this school is admirable, for it is in the biopsychosocialspiritual aspect (though our principles and perspectives did not emphasize the spiritual) that should be our foundation of approaching medicine. But instead, we are tempted to make the same reductionist mistake when our foundations of what the psychological and sociocultural are not rooted in the apprehension of the good. Though it may not be manifest, one can implicitly make a supervenience argument thinking we're still just stuff and the mind is just a manifestation of that stuff. Or we can jettison it all together and make the Platonic error thinking all who we are are merely just spirits or the cartesian flavor that posits us as ghosts in the shell. I call these errors not because I dislike them but rather because there's a lot to disagree with them for reasons that they don't fully capture the meaning of human nature, but "reduce" it to merely just the body or merely just the mind/spirit. 

We aren't just our minds or even just our consciousness. Otherwise we wouldn't be "alive" if we're asleep or find ourselves spacing out. What is missing is the metaphysics of human nature. A human is a rational animal whose lived experience shows the human as a person as well. So reason is still emphasized in a proper metaphysics of human nature. Every human being has the capacity for reason, an "active potential" to express this nature. We may not express our nature when we sleep but we are actively moving towards it when we wake and when we study and learn. If we ditch the "active potential" to express the human nature, then when we are not expressing our rationality then we suddenly aren't human anymore, but merely a "clump of cells" or a "vegetable". This is an offense to human dignity shared by all humans. Why this is so important to medicine is particularly because medicine is the intersection of all cultural activities of humanity– science, humanities, arts, religion; and medicine is also at the foundation of all of them. If we aren't healthy then we experience a break with all these activities we engage in.  

In the very short amount of time I've been here at Ateneo's school of medicine and public health (not just this one week but also the month-long orientation module prior), I acknowledge that it is a new school– it did start in 2007. I even admire its public health initiatives. Again, I don't have anything wrong with the curriculum. It has a huge emphasis on "mental health" initiatives, and I'm a huge advocate for the campus ministry. I am just aware of the underlying crypt of the malaise of medernity that can occur from not making the foundation of the good prominent. And this malaise isn't just internal but a cultural mood. There are many sources for this, and each student has a unique story to tell and to wrestle with. Perhaps we can look at the decaying of our own society that may desensitize us to any sense of the good. Corruption scandals and distrust in the government can bleed into our study of medicine– either for good or for bad. But how do we deal with this? Some can throw themselves into their studies and block out the world, or perhaps they can get over-involved with it due to wanting to be "authentic" and not just a cog in the med machine– both are excesses. One solution is offered by our school as well– the Examen: to take 15 minutes at the end or start of the day to reflect on thanksgiving, grace, to review one's day, consider areas of reconciliation, and to hope. 

I am not sure whether or not it is just as effective if we tell people who are agnostic/atheist that the Examen isn't just a Catholic thing. I think we should double down on it being a Catholic thing. In fact, Fr. James Martin's book the jesuit guide to everything invites all people to do it. Emphasize the Catholic (in greek meaning "of the whole") because the richness of the force behind Catholic can be lost to cultural impressions. I think this is the reason why some people are rather allergic to the word "Catholic", to the point of downplaying it when it is mentioned (in a predominantly Catholic country), is because of once again another malaise of modernity. The Catholic Church remains consistent in wielding "reason" even if it's unfashionable, and people don't appreciate this enough, potentially suspicious of the consistency of the good (shouldn't the good change as I change? no actually, the good remains while we change). Even if one disagrees, one must admit and appreciate the consistency of the thought of Catholic teaching. This is why the Examen is Catholic, because it is consistent in asserting that this exercise is spiritual, because of the fact that it asserts that we are spiritual beings. Again, "And if we are spiritual, then we are incarnate spirits". And also to remind from last week, the Jesuit project really is evangelization through studying– because faith and reason do not contradict. That is what we should think of when we think Catholic: no contradiction between faith and reason. This may very well be the cure to the malaise of medernity, in-house and foundational but potentially ignored and underappreciated. Because at least we have a sense of something outside of ourselves (step one), which we will find to be inherently good (step 2) and ultimately recognize it as the source of love itself (step 3). Because it is very lonely and potentially anxiety inducing if all everything is is just mental impressions projecting to us. Something is pulling at us that we can't attribute its origin to ourselves. It's time to stop repressing it but to sublimate it in the way we study, to be supported by it when we review, and to pray to it when we take our exams (even if pray just means to ask or to have a conversation with it). 

To end, I appeal once more to the skeptics of spirituality in the form of a long quote. When still a Franciscan friar, in his book The Healer's Calling, Dr. Daniel Sulmasy makes an important observation in terms of spirituality: 

"Anyone who says, "I don't believe in God, but I'm a very spiritual person" is obviously offering a reflection about something he or she has experienced. And since they are calling it spirituality, I suspect that they are talking about an experience of something other than themselves. So it is an experience of something or other that is either outside them or inside them but not equivalent to them. And unless they think that they were hallucinating, it follows logically that such persons will also believe that whatever it is that is giving rise to their experiences must exist....  

"Nonetheless, I can talk meaningfully about spirituality with such people. If they affirm the experience and believe that it has a source, then we might not give it the same name or believe exactly the same things about the nature of the source of spiritual experience, but we will share the belief that we have a relationship with it, whatever it is. Even the atheist who denies not only God, but spiritual experience as well, still has a relationship with both, at least as propositions to be denied. "