MEDICAL SCHOOL training in the Philippines has been criticized as being biased for urban settings, with doctors trained to work in hospitals, using expensive technologies and procedures.

There has been no lack of a search for alternative models. For several years now, the University of the Philippines has been implementing a ladderized medical training program where students get to earn degrees in community health or midwifery and nursing before finally becoming a medical doctor (MD). Students are actually community scholars and, after getting each degree, they have to go back to serve in their hometowns for a certain period.

The program is under the UP College of Medicine but has its own academic unit: the School of Health Sciences. The first campus was set up in Palo, Leyte, in the 1970s and, in recent years, has expanded to Baler, Aurora and General Santos City in South Cotabato.

Last month, Dr. Teodulio M. Topacio Jr. delivered a UP Centennial Lecture at UP Los Baños proposing still another model to better respond to health needs in the country. A National Scientist, former dean of the UP College of Veterinary Medicine and now emeritus professor, Dr. Topacio has dedicated his life to veterinary medicine as well as human public health.

I had the privilege of being one of Dr. Topacio?s students (which is why I insist on writing about him with the ?Dr.?) and we have maintained contact through the years. When he first began to prepare his paper he asked if he could share some of his ideas with me and I immediately obliged.

Medicine in UP Diliman?

I learned that the UP College of Medicine, which has always been in Manila, was nearly transferred to the Diliman campus, with then president Carlos Romulo first proposing a new site in 1962. The Philippine General Hospital (PGH) would have been kept in Manila but the medical school was thought to be more appropriate in Diliman. The board of regents approved the proposed transfer and the Rockefeller Foundation agreed to fund a new medical complex, even sending a group of advisers who lived on campus in Diliman in what is now known as Purok Aguinaldo. Dr. Topacio, then dean of the College of Veterinary Medicine (which was also in Diliman), was invited to help plan this new medical complex.

Plans for the transfer were aborted though when student activists protested and held rallies in front of the Americans? Purok Aguinaldo houses. Rockefeller pulled out and that was it.

The College of Veterinary Medicine transferred to Los Baños in 1985, and Dr. Topacio continued to dream about a more integrated approach to human medicine, to involve veterinarians. In his UP centennial lecture, he pointed out that scientists have identified, globally, more than 800 zoonoses or diseases that can be transmitted from animals to humans. In the Philippines alone, there are about 45.

Rabies is one of the more deadly zoonoses, with the Philippines having one of the highest rabies death rates in the world.

Many Filipinos are aware of leptospirosis which we associate with rat urine contaminating flood waters, but the disease breaks out not just during typhoons and floods but is a daily threat to farmers, who can get infected through contaminated rice fields.

Dr. Topacio is also pushing for a College of Comparative Medicine, pointing out that human medicine has much to learn from studies around animals. He mentioned metabolic syndrome as an example, the syndrome being caused by obesity, which leads to diabetes and heart disease. Researchers at Purdue University have been looking at how the syndrome develops in pigs, in a search for prevention methods as well as treatment.

Pigs actually come close to humans when it comes to anatomy and physiology. Pig heart valves, for example, have saved many humans with defective valves. In forensic research on the processes involved in the decay of corpses, it would be too difficult to use human corpses so pig carcasses are used instead, again because they come closest to humans.

Agromedicine

Given all these potential inks between human and veterinary medicine, Dr. Topacio is resurrecting his dreams of a more comprehensive medical training program, to be based in UP Los Baños. He calls for the creation of an Agromedicine Center which will involve four academic units: the College of Veterinary Medicine, the College of Agriculture, a Food Safety Research Center and a College of Human and Comparative Medicine. The units would offer courses in rural medicine, occupational and environmental medicine, nutrition and zoonoses.

The link between nutrition and health is not always emphasized enough in medical training so Dr. Topacio?s vision of a medical school in Los Baños becomes even more compelling. UP Los Baños is already a teaching and research hub for agriculture and the environmental sciences.

UP Los Baños would not be totally new to medicine. In 1997 a UP Los Baños committee headed by Dr. Dolores Ramirez already proposed a medical school in Los Baños with five-year curriculum with emphasis on community medicine. The medical school would have been attached to a tertiary hospital, providing specialized care. Unfortunately, a philanthropist who pledged money for this project backed out and UP Los Baños had to set aside the project.

For many years, too, the UP College of Medicine had a comprehensive community health program where students were deployed in Bay, a town next to Los Baños, for exposure to rural conditions. Medical students actually lived in the community, going house to house doing surveys as well as extending medical services. Partly because Bay was becoming too much of a social laboratory, the residents complaining about being ?surveyed to death,? the UP College of Medicine now sends students to San Juan, Batangas, instead.

As a veterinarian who ?drifted? into human public health and a medical anthropologist, I?m lobbying for Dr. Topacio?s project, and would add that social scientists could play major roles as well in this new medical complex. It was in Bay, Laguna, where anthropologist Felipe Jocano did his research on traditional medicine, the National Museum publishing his book, ?Folk Medicine in a Philippine Municipality,? in 1971. Recently reprinted, the book is considered a classic in medical anthropology in the Philippines.

Dr. Topacio quotes from Rudolf Virchow, a 19th century pathologist and public health advocate considered to be one of the pioneers of modern medicine: ?Between animal and human medicine there is no dividing line?nor should there be. The object is different but the experience obtained constitutes the basis of all medicine.?

This ?one medicine? concept of Virchow could hold the key to a more responsive health care system in the Philippines.

Email: mtan@inquirer.com.ph